Child Abuse Fatalities Among Internationally Adopted Children
Laurie C. Miller
Robert A. Reece
Linda Grey Tirella
International Adoption Clinic, New England Medical Center
Adam Pertman, Evan B. Donaldson Adoption Institute
More than 250,000 boys and girls have been adopted from other countries by American parents since 1989 (Immigrant Visas Issued, 2006). Most of these children have experienced prenatal risk factors (low birth weight, prematurity, lack of medical care and/or exposure to drugs, alcohol, tobacco), as well as risk factors associated with institutional care (growth and developmental delays, medical problems and/or lack of individualized attention) (Gunnar, Bruce, & Grotevant, 2000; Jenista, 2000; Johnson, 2002; Miller, 2005a). As a consequence, internationally adopted children frequently experience a complex array of developmental, medical, and behavioral issues (Hjern, Lindblad, & Vinnerljung, 2002; Miller, 2005b; Rutter et al., 1999; Tizard, Cooperman, Joseph, & Tizard, 1972; Tizard & Hodges, 1978; Tizard & Joseph, 1970; Verhulst, Althaus, & Versluis-den Bieman, 1990a, 1990b, 1992; Verhulst, Versluis-den Bieman, van der Ende, Berden, & Sanders-Woudstra, 1990; Versluis-den Bieman & Verhulst, 1995). Nevertheless, most of them exhibit remarkable catch-up growth and development within months after arriving home.
Parents who adopt internationally are generally recognized as an extremely devoted and committed group, who literally “go to the ends of the earth” to form their families. As with other types of adoptions, prospective parents frequently wait for months or even years to complete their international adoptions. Procedural delays and setbacks are common in international adoptions, due in part to the complex requirements of U.S. and foreign government bureaucracies.
Throughout the process, significantly, there are multiple opportunities for agencies to appraise and educate the prospective parents. Parents who adopt in any way, for instance, must undergo a “home study” by a licensed adoption agency to meet legal requirements. Home studies are conducted by trained social workers, in part to obtain comprehensive information about the personal lives, child-rearing beliefs, and psychological preparedness of prospective adoptive parents. Because international adoption is a long and intensive process, agencies often have the opportunity to assess prospective parents under diverse and stressful conditions.
Thus, it has been shocking and horrific to realize that, since 1996, there have been 18 fatalities (in 17 families) of internationally adopted children because of suspected or proven cases of abuse and/or neglect by their adoptive parents. Adoption officials and child welfare professionals in the United States and the children’s countries of origin are understandably concerned, in some cases alarmed (Correspondent, 2005; Morton, 2005; Weir, 2005). Seven girls and 11 boys (14 adopted from Russia, 2 from China, 2 from
Guatemala) have died from causes related to head trauma, suffocation, or neglect (Associated Press, 2004, 2006; Barakat, 2006; Bowers, 1997; Correspondent, 2004; Gordon, 2003; Gurr, 2006; Joyce, 2004; LeMignot, 2005; McCarthy, 2006; McClure, 2005; Reilly, 2001; Robinson, 2006; Ruth, 2004; Sector, 2005; Van Sack, 2002; Vargas, 2006). In 12 of these cases, the mothers were directly accused in the deaths of their children, and in four cases, fathers were directly accused (one of the fathers committed suicide after killing his wife and two children). In the remaining two cases, both parents were accused. The victims were age 36 months or younger in 12 of the 18 cases (67%); the remaining
children were between age 5 and 11 years. Nearly one third of these children died within 6 months of their adoptive placements, and more than one half of these deaths occurred within the 1st year after adoption. At least five families had simultaneously adopted another child, and in five other families, there was at least one other adopted child already living in the home. There have been five deaths in the New England area, two in New Jersey, two in Ohio, one each in Colorado, Indiana, Virginia, North Carolina, Georgia, Tennessee, Illinois, Maryland, and Minnesota. In at least one case, the defense provided by the adoptive parent was that the child’s injuries were self-inflicted, due to severe behavioral
disturbances such as reactive attachment disorder. In other cases, defendants claimed that the children had violent outbursts. In addition to these 18 children, at least two other internationally adopted children (residing in Sweden and Northern Ireland) allegedly have been killed by their parents; these children were adopted from the Czech Republic and Romania, respectively (Lazarova, 2006; Lewis, Cole, & Williamson, 2003). The number of internationally adopted children who have been seriously injured by their adoptive
parents is unknown.
Adoption has existed throughout recorded human history. In recent decades, national and international legal and social safeguards to protect adopted children have been widely promulgated. The vast majority of internationally adopted children thrive in their loving, supportive families. Their lives are immeasurably enriched by the opportunities provided by their families, far beyond what would have been possible if they had remained consigned to institutional care in their birth countries. These 18 cases of abuse and neglect are consequences of extreme circumstances and do not reflect the norm among families of internationally adopted children. However, pediatricians and other professionals caring for internationally adopted children must be especially vigilant in identifying parents who may be showing signs of depression, stress, or extreme disappointment. “Postadoption
depression” is becoming more widely recognized and may even be more common than postpartum depression (Foli & Thompson, 2004). Whether postadoption depression contributed to these fatalities is unknown. However, the deaths of these children remind us that traveling a long distance to adopt a child does not prevent a susceptible parent from becoming abusive.
It is incumbent on all practitioners to educate prospective parents for the challenges they might face, and to appraise these men and women for signs that they might have unrealistic expectations or might not be emotionally ready in other ways. Moreover, to facilitate further discussions about matters of concern, professionals involved with these families should offer open-ended questions regarding the child–family transitions, gauge the parents’ ongoing satisfaction with the adoption, and help them understand and
deal with the reality of adoptive parenthood compared to what had been anticipated. Adoption agencies, in particular, must be vigilant about looking for red flags indicating families in crisis as they complete their mandated postplacement reports and visits. All professionals involved with internationally adopted children and their families must be alert to the warning signs and must be willing to decisively intervene—as early as possible—to protect the children.
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Laurie C. Miller, MD, established the International Adoption Clinic at New England Medical Center in 1989. She is an associate professor of pediatrics at Tufts University School of Medicine and is the author of The Handbook of International Adoption Medicine (2005), Encyclopedia of Adoption (with C. Adamec, 2006), and more than 70 peer-reviewed articles in pediatrics.
Wilma Chan, BS, graduated from Tufts University in 2003, after majoring in child development and biology. She worked as a research assistant in the International Adoption Clinic program at New England Medical Center for 3 years. She is currently a second- year medical student at Tufts University School of Medicine.
Robert A. Reece, MD, is clinical professor of pediatrics at Tufts University School of Medicine. He has been the chair of the Child Abuse Section of the American Academy of Pediatrics and has served on the executive committees of the American Professional Society on the Abuse of Children, Prevent Child Abuse (America), and the National Children’s Alliance. He is the editor of three editions of Child Abuse: Medical Diagnosis and Management, the editor of Child Abuse Treatment, and is the executive editor of the Quarterly Update.
Linda Grey Tirella, OTR/L, MS, MHA, has worked at the International Adoption Clinic as a developmental therapist since 2001. She has specialized training in sensory integration disorders and 18 years experience as a therapist in the public schools working with children with developmental disabilities.
Adam Pertman is the executive director of the Evan B. Donaldson Adoption Institute, the preeminent research, policy, and education organization in its field. He also is the associate editor of Adoption Quarterly, the premier academic journal in its field. A former journalist who was nominated for a Pulitzer Prize for his writing about adoption, he is the author and editor of numerous articles and book chapters on issues relating to adoption and foster care. His book Adoption Nation has been reviewed as “the most important book ever written on the subject.”
CHILD MALTREATMENT, Vol. 12, No. 4, November 2007 378-380
© 2007 Sage Publications
Authors’ Note: Address correspondence to Laurie C. Miller, MD, Box 286 NEMC, 750 Washington St., Boston, MA 02111; phone: 617-636-4285; e-mail: email@example.com.
We thank Thais Tepper and Daniel and Elizabeth Case for helpful discussions and bringing some of the details of these cases to our attention.
CHILD MALTREATMENT / NOVEMBER 2007
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