Physicians, counselors and adoption advocates say they are troubled to see a small but growing number of families taking the once unthinkable step of dissolving adoptions of severely disturbed children from Russia or Eastern Europe.
No federal agency or private organization keeps statistics on how many of the 120,000 adoptions in the United States each year are dissolved. But Dr. Ronald S. Federici, an internationally known developmental neuropsychologist, said he was seeing "a much higher incidence of problem cases" that lead to failed adoptions among Russian and Eastern European children he treats.
Federici, of Alexandria, Va., is noted for his work with disturbed, formerly institutionalized children. He often is the doctor of last resort for families who have been unable to find appropriate psychological help for their children.
"The number is on the rise rapidly," said Federici, whose practice handles three or four cases each month that end in disruption, the term professionals use for terminated adoptions. "It's so sad."
Some of those cases have attracted international attention.
* In February, a Georgia couple was featured on the CBS news magazine show "48 Hours" as they took their 9-year-old adopted daughter back to Russia, saying they couldn't find the psychological help they needed in the United States. They later dissolved the adoption.
* In July, Denise K. Thomas, 42, of Littleton, Colo., pleaded guilty to misdemeanor charges of child abuse and seeking unlawful compensation for adoption after being accused of trying to sell her 8-year-old Russian-born daughter on the Internet. Thomas contended she was trying to find a new home for the girl after making the decision to disrupt and wanted to recoup some of the costs of the girl's adoption and medical care.
These and similar cases enrage many families, adoption agencies and support groups that, over the past nine years, have been involved in thousands of adoptions of Russian-born children.
They contend the media have blown a few cases out of proportion while disregarding the successes they've had with healthy, thriving children. They also worry that prospective parents who hear about those cases may be dissuaded from adopting.
Doctors and advocates calling attention to the failures respond that they are trying to improve, not destroy, the international adoption process.
That attention helped to prompt the Russian government earlier this year to overhaul its adoption system.
"Adoption is a wonderful thing. I would never say to anyone, `Don't adopt,' " said Barbara Holtan, director of adoption services for Tressler Lutheran Services, an agency that finds homes for hard-to-place children in Pennsylvania, Maryland and Delaware.
"Nobody's saying curb the flow [of foreign-born children]," said Holtan, herself an adoptive mother of Vietnamese and Korean children. "But there has to be growing understanding of this problem we're facing and more resources put toward specialized training to stop it."
Dissolving an adoption is neither new nor limited to foreign-born children. Numerous researchers have studied it and have reached differing conclusions about how often it occurs.
One study by Case Western Reserve University associate professor Victor Groza suggests that fewer than 2 percent of all adoptions fail. Other studies indicate that the risk may be as high as 10 percent to 20 percent for children who are older, have health problems or come from foster care or institutions.
Those criteria apply to many of more than 1 million children who are eligible for adoption in hundreds of orphanages in Russia and former Soviet bloc nations. Also, Russia's approach to operating orphanages differs from that of China, Korea and other popular destinations for would-be parents from the United States.
While some Russian orphanages in poorer regions are shabby and inadequately supplied, others in Moscow and St. Petersburg are clean and well outfitted. But generally, orphanage officials rely on strict routine to run their facilities.
There is high turnover among orphanage workers, who have so many demands on their time that they often spend no more than a few minutes each day touching, feeding or talking to each child.
Lack of interaction and stimulation often results in children who are developmentally delayed, who never learn to bond with others and who are seriously depressed or schizophrenic. And many of those children ended up in orphanages after being subjected to prenatal drug or alcohol abuse, sexual abuse or abandonment by birth parents.
After the fall of the former Soviet Union, Russia in 1991 began allowing outsiders to adopt its orphans. Russia also allowed parents to finalize adoptions before leaving the country, unlike nations that required parents to first serve as guardians and to be monitored for a period of time.
Offering white children whose birth parents could not reclaim them, Russia quickly became the top provider of children for adoptive U.S. families.
"Those children often were placed at a very young age in institutions," said Madelyn Freundlich, who, until recently, was executive director of the Evan B. Donaldson Adoption Institute, a New York City think tank. "They are clearly at greater risk because of their early life experiences."
About three years after Russia opened its doors, Holtan said, Tressler Lutheran Services began getting telephone calls from families that, after adopting in Russia, had been unable to find effective treatment for their troubled or violent children.
"It was like nothing we'd ever seen before," Holtan said. "By the time we got eight or nine of these calls, I thought, `Oh, my God, what is going on here?' And it hasn't let up at all."
Since 1994, Tressler has been asked to find new homes for 103 children -- about 17 each year -- whose adoptive families said they no longer could keep them. Most were from Russia; the rest were from Romania or former Soviet nations.
Tressler workers also were alarmed to see that children whose adoptions were dissolving were young, sometimes no older than 4. Usually, adoptions are more at risk when the children are older.
Holtan's observations are "the prevailing sense in the field" of agencies and doctors specializing in adoption issues, Freundlich said.
Dr. Jerri A. Jenista, an Ann Arbor, Mich., pediatrician who, in 1982, became one of the first U.S. doctors to specialize in adoption issues, said in her first 15 years of practice she needed one file drawer to hold records for difficult cases.
In the past 3 1/2 years, Jenista said, those files require 250 storage boxes or drawers which contain records for 7,800 children. The majority were from Russia, followed by other countries in Eastern Europe.
Jenista said she had one case end in disruption in her first 15 years of practice; she's had at least five in the past three years. She can't be sure how many more adoptions have failed, because parents may not decide to terminate the adoption until after consulting her.
Also noticing an increase of inquiries about disruptions is Thais Tepper of Washington, Pa., who operates the Parent Network for the Post-Institutionalized Child, an internationally recognized support and advocacy group.
In the first 10 days of July, five families planning to dissolve adoptions sought her advice. Of those families, Tepper said, three adopted from Russia, one adopted from the Republic of Georgia and one adopted from Romania.
One family was seeking to terminate their adoptions of three Russian siblings.
Some of the families had been unable to help their adopted children curb violent or destructive impulses. Others had exhausted health-insurance coverage and savings and could not obtain subsidized health care because they'd signed pledges to financially support the children in obtaining visas for them.
After parents make the painful decision to dissolve an adoption, there are a handful of places around the country that provide guidance.
In Pittsburgh, some turn either to Project Star or Every Child Inc., both of which handle adoptions as part of their work with at-risk families. Elsewhere, they turn to agencies such as Tressler Lutheran Services that try to find new homes for their children from a pool of volunteer families that have undergone intensive training.
But those agencies never have enough trained volunteers. Holtan said between 50 and 60 of the 103 families who sought help from Tressler in recent years still are waiting for new placements for their children.
Still others turn to their pediatricians or other specialists who've treated their children. Federici and other doctors who specialize in adoption medicine also maintain contacts with volunteers who'll take children, but they, too, say volunteers are in short supply.
Adoption professionals often try to persuade families to change their minds by offering to link them with specialists or treatment centers that might help their child. By the time they've contacted a doctor or agency about disrupting, however, most families already have made up their minds, Holtan said.
If a private placement can't be arranged, some parents relinquish their children to already-overburdened child-welfare agencies. By doing so, they run the risk of being charged with child abandonment, and they almost certainly will be required to pay child support until the child is adopted again or turns 18.
Between eight and 10 children now are in the custody of Allegheny County's Children, Youth and Families agency because their adoptive parents have relinquished them, agency spokeswoman Karen Blumen said. Although that's an average number of children, in recent years more of them have been from Russia or elsewhere in Eastern Europe, she said.
As in most states, Pennsylvania's Department of Public Welfare does not track disrupted adoptions. But during the past four or five years, child-welfare workers and foster parents nationwide have handled increasing numbers of Russian and Eastern European children whose adoptive parents have given them up, said Judy Howell, president of the National Foster Parent Association.
"This is coming at a time when the numbers of American-born kids in foster care is huge, beyond management," Holtan said. "It puts another added burden on our local systems."
Tepper said she even knew of families that, after exhausting other remedies, boarded planes to Russia and left their children at the orphanages from which they were adopted.
To stem failed adoptions, experts and adoption supporters agree, several things must happen.
Foremost, they back legislation requiring federal oversight of international adoption. The U.S. Senate unanimously approved that legislation July 27; the House of Representatives, which had approved an earlier version, is expected to pass the Senate's version in September.
They also agree that:
* Agencies must require more exhaustive screening and parents must take a harder look at their own motivations before they adopt overseas. International adoption has become so expensive -- up to $30,000 plus travel costs -- that only more affluent families can afford it.
Those folks are likely to be well-educated achievers who want their children to grow up to be like them.
They shouldn't adopt, or be permitted by an agency to adopt, if they can't accept a child who, with help, could become a loving member of their family but will never be admitted to Harvard.
* Adoption agencies must be required to uncover and provide families with all available information about their children's health and emotional disorders and must be frank about the possible effects of those disorders.
While some agencies offer decent pre-adoptive classes, others skim over potential problems or don't address them at all. Many adoptive parents have accused agencies of deliberately withholding information.
"Preparation ahead of time is absolutely the way to prevent [disruption]. When parents have been prepared and know what resources are there to help, they deal with problems beautifully and their kids are coming along nicely," said Dr. Sarah H. Springer, a pediatrician at Mercy Children's Medical Center. As medical director of the hospital's International Adoption Resource Center, she treats about 300 foreign-born adoptees, about half of them Russian.
Springer and Jenista, both of whom are adoptive parents, suggest that parents who adopt overseas should be required to attend classes like those required of parents who adopt special-needs children in the United States. That's also recommended by the Joint Council on International Children's Services, the world's largest coalition of licensed, nonprofit international adoption agencies and advocacy groups.
* Parents should demand that agencies provide them with detailed records about their children before they travel to Russia.
"I would never adopt a child without an independent translation [of medical records.]. You have to ask questions," said Dawn Davies of Families for Russian and Ukrainian Adoption, a Virginia-based support group for adoptees and parents.
"You have to view it like a consumer. [Adopting] is not a commercial transaction, but it is for the rest of your life and the rest of this other person's life."
* Agencies should be required to provide more extensive advice, referrals and services to families that experience problems after adopting. While the JCICS recommends its agencies provide those services, no entity requires agencies to do so.
"I can't vilify anyone who comes to that point [of disrupting]. It's an agonizing decision and often it comes down to the safety of other people in the family," said Springer, who's treated two families that later dissolved their adoptions and has consulted on other cases.
"But when difficulties come, it's about knowing where to find a psychologist or therapist who can make the difference. If you find them, you don't have to end up in disruption.
"Disruption is a hundred times worse than divorce. It's divorcing your child. But if families know ahead of time what they're dealing with and they find the resources to deal with their kids' really major issues, their circumstances are more manageable."