Broken Dreams; In some foreign adoptions, hope fades to hard reality
Newsday (Melville, NY)
First of three parts
Author: Stephanie Saul. STAFF WRITER
IT WAS a masterful deception, Martha Prokop believes.
In a sparsely decorated orphanage office in Romania she met a docile, blond, 6-year-old boy. He helped himself to a soft drink, happily accepted a candy bar from the orphanage director, and, finally, sat in Prokop's lap.
He had a "corrected" problem with ear infections as a baby, the orphanage director told Prokop after scanning his medical records, written in Romanian.
But when Prokop returned to pick up her new son, the quiet, cooperative boy was implacable, screaming and raging. Prokop thinks he was bribed with the candy and soda and probably sedated with drugs during their first meeting.
"The first day I got him, he screamed and yelled. There was no way I could get him to calm down," she said. The second day he tried to climb out a seventh-story hotel window.
On the third day, Prokop got truly horrible news. Medical tests required before leaving the country revealed that the boy, Remus, had hepatitis D, a rapidly progressive and potentially fatal form of the disease. The diagnosis was also in the orphanage's records, which she obtained four days after the adoption was completed and just as she was leaving the country.
Struggling to raise the emotionally damaged and physically ill child in their Virginia home, Prokop, an elementary school teacher, and her husband, David, a computer systems engineer, have sued the adoption agency, Welcome House Social Services of Perkasie, Pa., for $1 million. Their lawsuit says Welcome House's Romanian lawyer knew about Remus' condition and should have warned them. The adoption agency denies the charges, saying the Prokops bypassed normal agency procedures to adopt their son.
The lawsuit is one of a growing number of cases against agencies engaged in a burgeoning business - the international placement of orphans. Samuel Totaro Jr., a Bensalem, Pa., adoption lawyer representing the Prokops, said the agencies have failed to prepare parents adequately for the difficulties their children may face. "Some of the children simply cannot live outside an institution," Totaro said. Totaro, who is representing six families in cases against their adoption agencies, is among a group of attorneys planning a meeting this month in Las Vegas to discuss such lawsuits, an emerging area of law.
The adoption of foreign children by Americans is a relatively new phenomenon. More than 59,000 foreign children have been adopted by Americans since 1990, as the demand for foreign children and the number of agencies handling foreign adoptions has grown. In fiscal year 1996, which ended Sept. 30, 11,300 foreign children were adopted by Americans, an increase of more than 1,500 from the prior fiscal year.
Most of the adoptions helped create happy new families. But adoptive parents and some adoption agency groups say many of the children, particularly those from institutions in Eastern Europe, have emotional problems, learning disabilities and neurological problems ranging from mild to very severe.
Stories like Prokop's are repeated over and over. Parents who tell the stories believe they've been deceived. They thought the children would be all right, but some experts say 15 percent to 20 percent are severely impaired, not only with physical problems but also with autism, mental retardation and serious behavioral disorders. A few have been given up by their American families, who found them too difficult to handle. Some of the children have ended up either in the foster care system or in state-run institutions, where their care is paid for by taxpayers.
The tragedy of these families is compounded by the fragility of the adopting Americans. Most of them are baby boomers who have been through years of humiliating and unsuccessful fertility treatments after delaying childbearing.
But many are fearful of domestic adoption, worried that the birth parents will change their minds or reappear years after the adoption. In reality, experts say, that happens infrequently. There are other uncertainties in domestic adoption of infants as well. Prospective parents must often place toll-free numbers in newspaper ads directed toward pregnant women and then wait for a response, a waiting game that can be costly.
"People like my husband and myself are very vulnerable because we are desperate for a child," said Kathryn Ballou, a university nursing instructor and doctoral student in Kansas City, Mo. "We had gone through infertility."
When former Eastern Bloc countries began opening their doors to adoption in the early 1990s, many infertile couples viewed the newly available foreign children, ethnic Europeans who often looked like them, as the solution.
Lynn Jacobs, president of an adoption agency trade group called the Joint Council for International Children's Services, said she gets "angry" when families blame their adoption agencies. In many cases, she said, the families rushed to adopt the children, sometimes ignoring their health problems. When the children first became available, neither the parents nor the agencies knew the extent of their problems, Jacobs said.
"Here are families who went over and said, `We wanted a baby so bad, we just thought it was going to be okay.' Now we all know that's not true," said Jacobs, founder and director of Adopt International, an agency in Redwood City, Calif.
Jacobs estimates that 15 percent to 20 percent of the children adopted from foreign orphanages are severely impaired. She says adoption agencies must prepare parents for the potential problems and give them the option of not taking children they can't handle.
"One hundred percent of our children internationally are damaged in some way, emotionally or physically. If you prepare the families for that, I don't consider all the adjustment issues that they have to go through as bad," she said.
Jacobs believes that the information available on children adopted from overseas is improving. She also says orphanages are improving and some adoption agencies, including hers, are sponsoring training programs to help the orphanages improve their care of the children.
A proposed international treaty, which requires ratification by 60 countries, would establish standards for international adoptions, now loosely regulated by state governments. Many U.S. adoption agencies support the standards and say they already are working to educate parents about the pitfalls of international adoptions.
But parent advocates and experts say some agencies continue to misinform prospective parents.
"This is today, now," said Thais Tepper, the adoptive mother of a Romanian orphan. She says the deception by agencies continues. Tepper's organization, the Parent Network for the Post-Institutionalized Child, is largely responsible for bringing to light many of the problems faced by the foreign orphans. The parent advocacy group, based in Meadow Lands, Pa., was started by Tepper and several other parents who sought answers to the problems their adopted children faced. Now its membership includes 1,100 families, mostly parents of foreign children with learning disabilities and behavioral problems.
Some experts agree with Tepper that adoption agencies, some fearful of financial loss, are reluctant to admit the problems.
"The agencies are not adequately informing the families of the potential risk factors," said Ronald Federici, an Alexandria, Va., neuropsychologist who specializes in diagnosing and treating post-institutionalized children.
Experts disagree on the severity of problems suffered by the adopted foreign children and the length of time the problems will last.
Studies have been conducted only on small groups. One study of 22 Romanian children adopted by families in Manitoba, Canada, revealed that health, development and behavior of the children improved after a year in their new homes. But 36 percent, or eight, of the children continued to show behavioral problems a year after their adoption. They included self-stimulating behaviors, failure to initiate eye contact and abnormal play behaviors.
Federici estimates that 20 percent to 30 percent of the children adopted from foreign institutions are normal, meaning they will have only traditional adjustment problems associated with adoption, and minor problems associated with learning a new language and culture. Thirty percent to 40 percent have moderate problems, including learning disabilities. Another 20 percent are severely impaired, with problems including fetal alcohol syndrome, autism, retardation, multiple brain injuries and a syndrome called attachment disorder, Federici said. Children with attachment disorder are often charming to strangers, yet cruel to their parents, siblings and pets. They are prone to violence and aggression.
There are no guarantees in adoption, even domestic adoption, just as there are no guarantees when parents have a child of their own. But adoption experts say more detailed information is available on U.S. children. More than a dozen adoptive parents of foreign children interviewed by Newsday complained that they were not prepared for the problems. Some of the adoptions occurred as recently as this past year.
In some cases, adoption agencies assured them that with good nutrition and love, their children would flourish. In some, parents say, they were told to ignore records that, had they been translated, would have revealed their children's disabilities.
"We were all sold a bill of goods that we could take these profoundly damaged institution kids and fix them," said Ruth Hladyk of Denville, N.J., who adopted twin boys from Russia. A growing minority of parents are acknowledging, painfully, that such children are too difficult to handle. Some, like Hladyk, have institutionalized their children or placed them with other families.
If they had wanted to raise a handicapped child, the parents say, they would have adopted an older child through the U.S. foster care system. They could have done that for free, avoiding the high costs of foreign adoption, sometimes upward of $20,000. What's more, domestic special-needs adoptions qualify for federal and state assistance, which is generally not available for foreign adopted children.
In many cases, the prospective parents took out second mortgages, borrowed from relatives and withdrew cash advances from their credit cards to pay the agency fees.
"If I had had an inkling of the problems this child had, we would have selected a child out of our foster system in this country and been paid to take him," said Ballou, the Kansas City nursing professor, who last year adopted, then relinquished, a daughter from Russia with severe problems. The girl is now living with another family. "We would have helped one of America's children."
Some adoption advocates, fearful that such stories will discourage parents from seeking foreign orphans, point out that the picture is not always so bleak, and they say that only 1 percent or 2 percent of the adoptions have ended with parents relinquishing their children. And many adoptive parents are thrilled with the children they've rescued from foreign orphanages.
Christopher Fritz a Kansas City, Kan., concert promoter and owner of the National Indoor Soccer League, said he was warned by his adoption agency before traveling to Kamensk, Russia, two years ago that his adopted son might have brain damage and partial paralysis. But the child is perfect, Fritz said.
"There is no brain damage," Fritz said. "He's the smartest four-year-old I've ever encountered. Strong as an ox. Totally together. He played soccer this summer. He's fast. He's tough. He's just a little trouper. And he's brilliant."
Adoption advocates say prospective parents are often deaf to the warnings of adoption agencies. "Often people do not hear what it is we tell them when we're preparing them," said Miriam Vieni, a Westbury social worker who conducts preadoption home studies for agencies. "They want to do this, and they're so optimistic . . . After you've explained and explained, people really do hear what they want to."
Twenty years ago, only a handful of agencies placed international orphans. Today, there are more than 300.
"Adoption is business," said Aaron Britvan, a Woodbury adoption lawyer.
"When you're dealing internationally, I tell my clients, you have to be extremely careful," said Britvan, cautioning that the international adoption market is largely unregulated.
While New York State oversees agencies based or operating in the state, there is little to stop out-of-state agencies, sometimes subject to less-stringent regulations, from placing foreign children with New York couples.
The emotional and developmental problems of international orphans have been brought to light largely through the Parent Network for the Post-Institutionalized Child. Tepper adopted her son Drue from an orphanage in Arad, Romania, in 1991. Tepper said her U.S. adoption agency told her that Drue was healthy, so Tepper was shocked when she went to meet him.
"He was covered with sores," she said. "He's got this big bump on his face. His head is flat in the back. He didn't look at you. He had this zombielike stare."
Tepper spent a sleepless night in Romania as she and her husband weighed whether to take Drue home. "I said, `Oh my God, I don't know what's wrong with him. Can this be fixed? Can it not be fixed? Do I just leave? Do I take him?' " Tepper's mind was filled with visions of her father, disabled in a World War II plane crash, lying in their home in a body cast.
The attorney said, " `Take him or leave him. This is the last train out,' " Tepper said.
"We just took him," Tepper said.
When they got back to their Pittsburgh-area home, Tepper recalled, Drue, then about 18 months old, remained mute and showed other signs of sensory disorders. "There was nothing you could do to comfort him. This went on for three months. When you touched him, he arched his back and screamed."
After more than a year of nurture in Pennsylvania, Drue still didn't make a sound. "I had gone on for two years thinking that Drue was the only child in the universe who didn't recover from this," said Tepper.
But at a 1993 Florida gathering of parents with adopted Romanian children, Tepper met the mother of another child with some of the same symptoms as Drue. She met another whose child didn't talk. The parent network was born.
Dr. Dana Johnson, a University of Minnesota pediatrician who has studied post-institutionalized children, said no one has broad empirical data on how many of the children are impaired, or to what degree. Johnson believes that the chances of a severe problem - such as attachment disorder, autism or mental retardation - are relatively low. Still, he cautions parents not to expect a "normal" child.
"I think everyone would be willing to say, `Your chances of having a child who is profoundly impacted are pretty low.' I just don't want to see families adopt children and expect them to be normal, because they're not going to be normal. But their degree of abnormality is usually something they can deal with if they're willing to put in the time and effort."
Johnson said, "It would be very unusual for a child to be in an orphanage for a year or longer and not be affected by that experience in some way or another. The question is: Is this going to be an issue that will affect the child for a long period of time, or is this the type of thing a child is going to recover from? The longer a child stays in an orphanage, the more profoundly the child is going to be affected."
Many experts in international adoption say the chances of serious problems are lower with a child from Latin America or Asia. "Wherever you go, if a child is institutionalized, you're running into problems," Johnson said. "But you will run into fewer problems in Korea or Latin America."
That is because there is less fetal alcohol syndrome in Asia and Latin America than in Eastern Europe, children from those countries tend to be younger when they are adopted, and orphanages there provide better environments, experts say.
Johnson said children from China, the leading source of orphans immigrating to the United States, arrive an average of nine months younger and with less institutionalization than orphans from Eastern Europe, who arrive around the age of 2.
"The kid from China would appear more robust and not as developmentally delayed. I think that's, in general, what we're seeing," Johnson said.
Susan Cox, director of development for Holt International Children's Service in Eugene, Ore., the country's largest adoption agency, said orphanages in Asia and Latin America tend to have a better atmosphere for children than those in Eastern Europe.
"I've seen children in dismal circumstances in Brazil, Vietnam and India, with very little in the way of good, clean clothes. Yet there's this energetic and lively spirit among the children that gives you a sense of confidence for their future," Cox said. In Eastern Europe, she said, the orphanage director can tell you a child's precise temperature, but the caregivers provide less emotional support to the children.
Some large agencies have curtailed or eliminated their Russian adoption programs. Still, Russia remains the second-largest source of foreign orphans, with 2,454 Russian children arriving in the United States in fiscal 1996, according to State Department figures. Other Eastern European countries whose orphans come to the United States include Romania, Bulgaria, Georgia, Latvia, Lithuania and Poland.
In addition to fetal alcohol exposure, other toxins pose difficulties, particularly in countries with pollution problems, said Federici, the Virginia neuropsychologist. "These kids have a lot of nutritional deficits, a lack of stimulation, and no schooling," he added. "Nutritional, medical and psychological neglect is high. It damages these kids' brains."
Federici recently evaluated the daughter of Ann Boylan of Hudson, Ohio, adopted from an orphanage in Magnitogorsk, Russia, a heavily polluted steel-producing city on the Ural River.
Boylan and her husband already had two biological children. "I cannot have any more children, and I wanted a larger family," she said in a recent interview. "I always wanted four kids. Domestic adoption was out of the question, financially."
Boylan said she contacted European Adoption Consultants, an Ohio agency, which suggested a child with a clubfoot and a little bump above her left eyebrow. The girl was to be "low fee" because of her clubfoot. While the child had a medical problem, it was correctable, and she was believed to be cognitively sound.
The Boylans took out a loan, using their car as collateral, to pay the $7,500 fee. But when Boylan went to Russia to pick up her new daughter, the child was in far worse condition than indicated, she said. "I went to the orphanage. She was very flaccid. Her hands were clenched. Her wrists were pointed in. Her legs were emaciated. She was very weak. Her skull looked like it was protruding," Boylan said.
Medical forms at the orphanage, later translated into English, said the child had perinatal encephalopathy and hypaxial damage, terms unfamiliar to Boylan. The agency "told me they just make these things up," Boylan said.
Like Tepper, Boylan hesitated. "But I had that guilt issue," she recalled. "If I leave her here, what will happen to her?
"We brought her home. We thought that love will heal all wounds. We fed her, and we loved her," Boylan said.
But the child is permanently damaged, Boylan has learned. The unfamiliar terms on her medical records meant that the girl, Gabrielle, is mentally retarded and neurologically damaged. Federici's evaluation revealed that Gabrielle is also autistic.
Now 4, she behaves like a 2-year-old. Rather than speaking in complex sentences common to 4-year-olds, Gabrielle utters two-word commands: "Juice, please." "Coat on." She flaps her hands in the air and puts her fingers in front of her eyes - both signs of autism. She is prone to unpredictable outbursts in public. "We cannot go out socially with Gabrielle," Boylan said.
The Boylans are in constant fights with their insurance company, which has been reluctant to pay for the therapy Gabrielle needs. She's enrolled in a special public preschool for developmentally delayed children.
"I love Gabrielle," Boylan said. "The amount of anger I have is that the adoption agencies need to be aware of these issues and present them to parents who are anticipating and planning an adoption."
"It's just awful what happened to Ann," said Margaret Cole, the adoption agency's director. "But there's not a lot I can do about it. She showed up to be an autistic child. Nobody had a clue, and all of a sudden she started having problems."
Cole said she doesn't remember what she told Boylan about the importance of Gabrielle's medical records. But she said 30 percent to 50 percent of children from Russia are labeled as having "perinatal encephalopathy and hypaxial damage."
Martha Prokop, the Fairfax, Va., mother who adopted a Romanian child with hepatitis, said she told her adoption agency, Welcome House, that she could not take a disabled child because she had already adopted a Romanian girl with significant learning delays and other problems.
Prokop's girl, Emelia, had been rescued from an orphanage in Moreni, Transylvania, by Mother Teresa. The children in that orphanage were considered "irrecuperable" and were living with no lights, no heat, no clothes and no access to toilets. The kids were starving and close to death, covered with sores and lying in their own excrement. The Prokops knew of their daughter's background and were aware that she would need extensive special tutoring and therapies.
When the Prokops brought their daughter home, they realized that while they had given the girl parents, they had taken away all her brothers and sisters. Emelia learned to speak English quickly and complained, "I outside talking all by self. I want a brother."
Because of Emelia's severe developmental and learning delays - she is old enough to be in the fifth grade, but works academically at a first-grade level - the Prokops specified that they needed a healthy child when they set out to adopt their son, according to Martha Prokop.
Remus is anything but healthy.
In addition to his hepatitis, Remus has been aggressive and violent. He has threatened Martha Prokop with butcher knives, kicked holes in the wall and kicked her in the crotch. He's been in a psychiatric hospital four times, once for five months. He described being sodomized with a gun in the Romanian orphanage.
In a statement, Welcome House predicted that it will be exonerated of charges in the Prokops' lawsuit. "Mr. and Mrs. Prokop failed to abide by the processes for Welcome House and, instead, acted on their own to expedite the process," the agency said.
Prokop, a devout Catholic, is sustained by faith. And by hope - hope that her son is responding to a new therapy that is reducing his aggressive behavior. The Prokops and their two children recently celebrated Remus' ninth birthday.