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General News

A Cautionary Tale for Adopting Parents (06/08/2010)

The recent incident of a distraught mother opting to send her newly adopted Russian son back to Moscow on a one-way-ticket prompted me to write this article. It's a cautionary tale with a happy ending in this case. As one of Cradle of Hope's "veteran" parents (Leonty, adopted 1993 at age 6.5 and Alexei and Sergei adopted 1996 ages 6.1 and 5.2 respectively) and as an on-line mentor to hundreds of parents who have endured significant difficulties with their adopted children, I both abhorred the recklessness of Torry Hansen's actions while understanding the desperation. Her reaction placed her son at terrible personal risk and put large numbers of Russian adoptions in peril, but it did serve as a very resounding (albeit perhaps unwanted) wake-up call. The purpose of my message is not to sugar-coat what can be a very challenging is to show you what can and often does happen if you stick with it instead of panicking, stay focused on the needs of your child instead if abdicating your responsibilities (no matter how difficult they make life for you) and determine to go the distance. In some cases, you may need to recommit your intentions with each new day.

This summer, I have had the rare and incredibly rewarding opportunity of watching all three of my boys pass major milestones. In early May, I watched my son, Leonty, who joined our family in 1993 with significant autistic-like behaviors caused by severe learning disabilities, sensory issues and auditory/language processing problems graduate from High Point University with a degree in Sports Management - and he already has a job! A few weeks later, my youngest son, Sergei who we strongly suspect suffers from alcohol-related neurological disabilities and joined our family with a list of diagnoses as long as your arm graduated from his special occupational high school program of work/study. North Carolina is the only state in America that offers such a program to handicapped children. And finally, this month my middle boy, Alexei who came to us with raging Post-Traumatic Stress Disorder and significant learning disabilities completed his first year of college and finished it with a more than decent GPA. Did we enter into the adoption process hoping we'd find special needs children with extraordinary challenges? No. We entered the process hoping, like most expectant adoptive parents that we'd find fully-intact though disadvantaged children who would benefit from living in a stable environment. Did we have moments when we worried we were over our heads or that we couldn't parent these children appropriately so they would reach their fullest potential? You bet we did - lots of them! But we also came to the conclusion that we, because of the resources we have close by were probably better equipped than a lot of folks to get them the help they would need - and to those ends, we were tireless.

We live in a large metropolitan area in the triad of North Carolina. Within a radius of 150 miles, we have two major teaching hospitals and 2 state universities with large departments that diagnose and treat complex neurological problems in children. We've been to three of the four looking for and finding answers. We also live in a large county with many school choices. Although we've occupied the same school district since adopting the boys, Sergei attended four different elementary schools over the course of six years - three public and one private - as we struggled to help find the instruction he needed to learn to read and manage basic life skills. The fact that these resources have been so close has been extremely helpful.

One of the refrains you'll often hear during the adoption process is "hope for the best; prepare for the worst". The accompanying refrain which plays in our heads and closely follows it goes," but the worst will never happen to us". Keep yourself from fully investing in that second refrain. It's not much fun looking for a good Neuropsychologist, speech pathologist, occupational therapist, or child psychiatrist in your local area when you think you may never need one nor is it exciting to have to interview your county special Education coordinator to see if there are appropriate programs for learning-disabled children. However, if you find that there are no resources in your local area or that good resources are too far away to be conveniently accessible, this should be a red-flag to you as an adopting parent of a child coming from Eastern Europe. There is plenty of access to good, factual, down-to-earth, scientifically-based information available about risk factors with post-institutionalized children. Good agencies like Cradle of Hope are conscientious about training prospective parents. Older children, like the boy from Tennessee who was sent back to Moscow may be at greatest risk. From my many years of working within the adoption community, it seems that the six-month adoption anniversary of an older child is a particularly critical time and here's the reason: communication has become very difficult due to the nearly total loss of the child's base language. And while he's been rapidly losing his base language, he hasn't had sufficient time to master much of the language of his new home - certainly not the complex and subtle language nuances he'll need for academics. Newly adopted older children are almost always placed into a school setting right away. Placement is often done by age rather than academic readiness which may put a child in the position of mastering a challenging curriculum with poor vocabulary skills. Frustrated children act-out and they sometimes get into trouble or have difficulty making friends. Add to this how hard a child is trying to learn the ins and outs of a brand-new culture while dealing privately with the emotions of being in his new family on top of dealing effectively with the grief he or she has endured prior to adoption. It's a lot for anyone, particularly a very young person who has just switched cultures, languages, living conditions, and family dynamics to handle with equanimity and grace. Seems like a "no-brainer" and that as a parent it would be so easy to stay in control of your emotions when your child is struggling, but when you're in the midst of this kind of a transition with a child whose behaviors can be extremely challenging AND you lack resources and support, it's understandable that you could lose focus and become desperate.

Nevertheless, you need to maintain a level head because you don't know how the story is going to end. Children aren't like books that let you skip to the back pages to see how things are going to turn out. Oftentimes, you're going to have to dig very deeply to find the answers, the patience, and the appropriate interventions to address the trauma these little people have suffered. You may feel like giving up. You may feel overwhelmed but you can't let that stand in the way of your commitment to do what's in the best interest of your child. The first thing to do if you find yourself in a situation like this is to get in touch with your adoption agency (or agencies if you used a different home study group) - not your travel agency. It goes without saying that we cannot send our children back once they are legally ours. We're not without options....this is just not one of them. Agency social workers have expertise that extends well beyond what it takes to put an adoption together. They can help you with strategies for your child's behavior management and make suggestions for appropriate therapies, and they can tell you what you need to do for yourself so you can stay afloat. That was exactly what I did back in 1996 after adopting little Sergei who came with all his unexpected baggage. Cradle was there on the phone each night we were in Moscow checking on how we were doing and after we came home we were in touch for several more years while our family did one therapy after another trying to help him. We wondered at times if he would ever be able to live independently but I've learned that all therapies have at least some benefit and some therapies do positive wonders. Over the years with consistent work Sergei's disabilities have become less impacting and it was clear that he was developing independent living skills. Just after his 18th birthday he finally managed to pass his driving test and get his driver's license. He also has a job and he drives himself to and from school and work. It seems such a normal thing but for Sergei this is huge.

One thing that has been a terrific advantage for all three of our boys has been participation in sports. My husband is the "sports guy". He played sports all the way through school as did his four biological kids. His two eldest grandchildren now carry on that tradition. The curious thing with our three boys is that they each played something different. Leonty was the basketball and soccer guy, Alex played ice hockey and lacrosse, and Sergei was the wrestler. Participation in sports gave them an identity and enabled each of them to be someone special at high school. Playing sports also gave them a non-academic outlet....a skill at which they could excel that didn't require reading or writing (because that was so hard for all of them). Because each boy had learning issues, we never pushed them to excel academically. Each had an IEP (Individualized Education Plan) that provided them with the tools they needed to succeed in school if they chose to apply the effort. What we did do was encourage them to do the best they could, but when we adopted these boys, we had no "grand plan" for them to become stellar whiz kids. I saw my job as getting them through high school - anything past that would be icing on the cake, so to speak. Although Leonty sputtered his way through most of high school, he got better grades as he went along and did get accepted to a terrific private four-year university from which he has just graduated. With Alex and Sergei, both of whom had such tremendous learning disabilities, I had never expected that either would go on to higher education. Amazingly enough, Alex surprised us all, got terrific grades in high school and was accepted to a state university. Then it was breath-holding time for me because I had my doubts about his ability to successfully manage a full college load with his learning disabilities, but he did surprisingly well his first year. We had considered getting him "official" help from the disabilities office but Alex felt he didn't need it, so this first successful year was truly an individualized effort. He's an amazing young man!

Perhaps the biggest success story of all though is the little boy who came with so many problems. When he joined our family he weighed only 29 pounds and had no language at 5 years 2 months. We learned he had endured unspeakable trauma before he ever entered an orphanage. Nevertheless, after lots of hit and miss school placements, he has been able to thrive in his special high school program. Although it is still extremely difficult for him to read, he has always tried his hardest at school where he is indispensible to the staff and helps out whenever and wherever he's needed. His work/study program had him placed at Wake Forest University's Graylyn International Conference Center this past senior year. Only ten students in our entire county were lucky enough to get into this special program which had very stringent academic, discipline, and attendance requirements. It also required that the candidates go through an interview process. The program has been a tremendous success and it was such a thrill to watch these incredible young people graduate from it knowing how much of an academic struggle it's been for each and every one of them - and for their parents. These young people now have legitimate work experience and the skills they'll need to go forward and be productive members of the work force. By the time they had presented their work portfolios and given their speeches there wasn't a dry eye in the room! In addition, Sergei won the President's Award for Educational Achievement for maintaining a 4 point average his entire senior year.

So there you have our story - at least up to this point. We've had exceptional good luck and good professionals helping us all along the way and that has been critical to our successes. My three boys are now moving into that transition time when they're defining their own lives and will someday go on to start their own families. There are still lots of chapters to be written, but it's a (mostly) happy story up to this point and the good news is that it keeps getting better as it goes along. So the message I leave you with is this; even though things may seem insurmountable at the moment, don't let yourself become overwhelmed. Help is available from your agency but there are also large support groups on-line comprised of people who have gone through the bumpy parts, know what works and are ready and willing to assist. So, make sure, if you're planning an adoption from Eastern Europe that you line up your professionals in advance and know you have access to services you may need near enough to you that you can get to and from therapies without a great deal of driving. Finally, get all the training you can prior to adoption and never hesitate to reach out for help if you feel you're in over your head.

Seeking Doctor's Advice in Adoptions from Afar (01/03/2006)

Doctor's Advice on Adoption

Dr. Johnson, a pioneer in the growing field of adoption medicine, is trying to assess the health and well-being of Dmitry for a family considering adopting him. Given the increasing understanding among adoption experts of the health risks facing orphans in certain developing countries, scanning a photo of a child has become a common practice, more reliable for finding abnormalities like fetal alcohol syndrome, which smooths the groove between mouth and nose, than for detecting imperceptible risks, like attention deficit disorder.

Those are generally hidden in the incomplete or incomprehensible medical records sent from orphanages. Dmitry's file is a litany of indiscriminate labels like "pyramidal insufficiency" - a red flag for cerebral palsy - that Russian doctors put on all infants born prematurely to impoverished mothers, Dr. Johnson said. Equally useless is Dmitry's hepatitis B test, administered too early to be of value.

Dr. Johnson will request more information. But even if Dmitry proves to be perfectly healthy on paper, Dr. Johnson will alert the prospective parents that most institutionalized children are marked by their early deprivation, some in minor and transitory ways and others with medical and developmental disabilities that will last a lifetime.

Maybe that warning will cost Dmitry a home. Maybe the family will ignore it because they yearn for a child. The best result, Dr. Johnson said, is that they will go forward better prepared for whatever challenges lie ahead.

"Any child does best in a situation where the family's expectations and the child's abilities are in sync," he said. "A child with low potential in an environment with high expectations is a recipe for disaster."

Since Dr. Johnson's clinic opened in 1986, the first of its kind in the nation, 200 doctors have swelled the ranks of adoption experts. Their specialty has been recognized by the American Academy of Pediatrics, and their clinics are fixtures at Ivy League medical centers.

In the same 20-year period, the number of international adoptions has tripled, to 20,000 a year. And a proliferating body of research has documented the effects of deprivation and the wide range of outcomes, from the happily-ever-after narratives typical in adoptions of Chinese girls to the rare accounts of child abuse largely involving boys adopted from Eastern Europe.

At Dr. Johnson's clinic here, some 2,000 children were assessed before adoption in 2005, using medical records, photos and videos. Also in 2005, 500 children were evaluated in person after adoption, and 100 of those received additional mental health services.

For adoption specialists this is a demanding time of year.

The children must be painstakingly taught to rely on their American parents after the blur of interchangeable caretakers in an orphanage. That is especially difficult when children arrive in the holiday season to a houseful of relatives all eager to fuss over a new baby.

In the days before Christmas, each clinic visit ended with a warning to be tough with cooing grandparents, clucking aunts and uncles, and boisterous cousins. Take Jane and Tom Raya, just home from China with 11-month-old Ivy Lee. Dr. Johnson and others on the clinic staff told Mrs. Raya that only she and her husband should feed, bathe or comfort the infant for the first few months.

Relatives should be restrained from bringing gifts, they said, and should ask for permission before picking up the baby.

"You and Tom must be the gatekeepers of all good things that come into her life for a while," said Kay Dole, the clinic's occupational therapist. "That is how you build a firm, trusting relationship."

Unlike adoptions from the American foster care system, which are tightly regulated, international adoption remains a free-for-all. Established agencies prepare families for the risks and urge them to seek adoption screening. But unlicensed "facilitators" abound, matching unsuspecting parents with sickly children.

Compounding the inconsistent preparation are an array of vigorous marketing techniques used to find homes for children who are older or in ill health. They include photo listings on the Internet and programs that place children briefly with host families, for summer vacations or the holidays. Both can promote impulsive decisions, and experts worry that they may cloud the judgment of adoptive families who fall in love first and ask questions later.

An unprepared family can be blindsided when its adopted child has delayed language and motor development, difficulty forming attachments and behavior that mimics attention deficit disorder or autism, all typical when children leave institutions for permanent homes.

Most children catch up, bond with their new families and settle down after they receive enough nourishment, stimulation and attention. But one in five are fundamentally scarred and never fully recover, according to several recent studies.

The critical variables, researchers have found, are the length of time a child is institutionalized and the conditions in the institution. Some studies suggest that families cope better with medical problems than behavioral ones and that it is unwise to adopt more than one child at a time, unless they are siblings.

Marc and Naomi Cline's consultation at Dr. Johnson's clinic presented a case study in the collision of expectations and reality.

Five years ago, with no preparation from an adoption agency, now defunct, the couple set off for the arid Kazakhstan steppes between Russia and China to claim two unrelated toddlers, Jacob and Corey, who are now 6 and 7. The Clines knew nothing of the effects of institutionalization on children, who on average experience a month of developmental and cognitive delay for every three months spent in an orphanage.

Nobody warned the Clines that institutions in the nations of the former Soviet bloc can be appalling places, where fetal alcohol syndrome, a permanent birth defect characterized by brain damage and stunted growth, is endemic. Nobody told them that reputable agencies discourage the simultaneous adoption of more than one unrelated child.

So the Clines have spent years trudging from doctor to doctor, seeking explanations for Corey's hyperactivity, indifference to his parents and learning difficulties. Jacob's physical development is slow, and he clings to his mother. That makes him easier to handle than his unruly, unresponsive older brother, but not necessarily less impaired.

The strains of infertility and then the jubilant arrival of two Kazakh toddlers sent Mrs. Cline reeling.

"Everybody figures you come home and you're one big, happy family," she said. "I expected it to be like a greeting card, but it doesn't happen that way. It's not like ordering something from a menu and it comes exactly how you asked for it."

Dr. Johnson, who adopted an infant from India 20 years ago, will review the boys' records, coordinate their care and most likely suggest a psychologist who understands the effects of institutionalization.

Adoption experts emphasize that the vast majority of adoptions succeed. Studies show that families back out in 10 percent to 25 percent of domestic adoptions; data is unavailable for international adoptions.

A family can refuse a referral from an agency - whether an evaluation alarms them or they change their mind - and hope for another. Once an adoption is legally completed, families unable or unwilling to keep a child generally work with their agency to find another home.

Tracy and Jeff Paschke Johannes, just back from Ethiopia with 3-month-old Shahra, made careful preparations before adoption, including getting a review here of the child's medical records and arranging an appointment for soon after the family's return. Shahra, to their delight, is not much different from other newborns.

She has dry skin from being bathed too often. She guzzles 28 ounces of formula a day, making up for lost nutrition after a bout of dysentery. She spits up because she eats too fast. Dr. Cindy Howard, who four years ago adopted conjoined twins from the Congo, suggested olive oil for the dry skin and rice cereal for the reflux. She also shared some of her experiences as a white mother of black children.

The Paschke Johanneses made a deliberate decision to adopt their children even before they married. They chose a Minnesota agency that had a new relationship with an orphanage in Ethiopia. The ratio of infants to caregivers was an unusual two to one, and Shahra was well cared for after a home birth to a 15-year-old mother.

Ethiopia, like China, is quickly earning a reputation as having good orphanages and healthy babies, with Guatemala close behind.

That is where Mary and Jim Hackney went for their first child, Mario, now 6, whose adjustment was uneventful. They expected the same when they made a second trip to adopt Alex, now 21 months old. But Alex has had one medical problem after another, including cataracts requiring surgery, a seizure and repeated ear infections.

During Alex's evaluation at the clinic, he banged his head on the wall and stared blankly when asked questions. Dr. Johnson predicted "learning challenges" for the boy but said cognitive evaluation was impossible until his hearing could be tested.

"I know this isn't what you expected," Dr. Johnson told Alex's mother. "But you're doing an absolutely splendid job."

Mrs. Hackney, who works with special-needs children, was matter of fact: "All kids present challenges. They just have their own ways of doing it."

Laurie Powell-Anderson's newly adopted son, 4-year-old Noah, also has limited language, hyperactive behavior and seizures. Noah was adopted from Kazakhstan less than a month ago along with an unrelated 11-month-old girl named Teagan. Ms. Powell-Anderson said she adopted both at the same time because she wanted two children but could afford only one trip.

Such adoptions are a red flag to many professionals, and so is Ms. Powell-Anderson's selection of Noah off a Web site that lists photos, where many people considering adoption can troll from the privacy of home.

Ms. Powell-Anderson recalls being captivated by "this chunky, defiant-looking little fellow in a suit and vest." Teagan's picture was also on the Web site, "but we didn't all have that 'yes, go for it' feeling," Ms. Powell-Anderson said. She added that Noah's difficulties might come from being in multiple orphanages where different languages were spoken.

Dr. Johnson said the best medicine for Noah's behavior was a predictable routine.

"No surprises," he said. "The same stuff at the same time every day. Pretend he's in the Army. And give him work to do so he knows what it means to be part of a family. Let him set the table. Fold the laundry. He doesn't need a lot of toys. And keep him away from the TV."

Ms. Powell-Anderson rolled her eyes. "My mother-in-law already thinks I'm a Nazi," she said.

"That's O.K.," Dr. Johnson replied. "Tell her it's doctor's orders."

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Psychologists glimpse biological imprint of childhood neglect (12/02/2005)

The absence of a loving caregiver in the earliest years of life could sway the normal activity of two hormones - vasopressin and oxytocin - that play an essential role in the ability to form healthy social bonds and emotional intimacy.

Announced by psychologists at UW-Madison, the new finding demonstrates for the first time that severe neglect and social isolation can directly affect a young child's neurobiology in ways that potentially influence emotional behaviors. The work is reported online in the Nov. 21, 2005 Proceedings of the National Academy of Sciences.

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News From Europe

HIV Children Become Outcasts (11/30/2005)

This year, World AIDS Day is different. For years, Russian journalists have conscientiously produced print and television reports on the scourge each Dec. 1 -- and that was about all the attention Russia paid to AIDS.

Note: This is a "Subscriber ONLY" article

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Post Adopt Announcements

Adoption Survey Results Are In (10/01/2005)

After years of work we have finished compiling the results of our Adoption Survey.

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General News

Does my child need a therapist? (10/24/2006)

Good information on how to evaluate when and whether your child need professional help.

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