Boston Globe Article

This article just appeared in the Boston Globe today.  GS

‘It’s scary sometimes’

With children being adopted from abroad at older ages, concerns for their health grow

Elsa Fever totters on tiptoes, all wide eyes and high-pitched squeals as she races into her mother’s arms.

The 3-year-old and her 4-year-old brother, Nate, clamber onto a couch with Cheryl Fever, muscling their way into as much of her lap as each can claim.

“Who’s adopted from Russia?” Fever sings out, her voice echoing in the spacious South Shore living room with the onion domes of Moscow gracing a stained-glass window.

“Me!” Nate chimes gleefully.

Elsa doesn’t sound so sure, but she, Nate, and their 6-year-old brother Aleks were all adopted by Fever and her husband, Peter, from Russia, chosen from orphanages in different corners of the former Soviet Union.

Aleks, adopted at 10 months, had the bowed legs of rickets when he came home, and both boys showed other reversible signs of poor nutrition – not unusual for children whose early lives are limited to orphanages. Elsa’s fate wasn’t so clear.

A growing body of medical evidence shows that while many internationally adopted children are remarkably resilient, others may forever bear the consequences of early physical and emotional deprivation.

Doctors often don’t know how well an adoptive child will fare, specialists in the field say. The most powerful predictor is what setting – an orphanage or a foster home – the child lived in before adoption and for how long.

Concern for these children takes on new urgency as political changes and stricter health screenings stretch the time it takes to complete most adoptions, meaning children are older when they join their American adoptive families. The proportion of children with special needs appears to be on the rise, while overall adoption rates fall, specialists say.

In several countries that have traditionally sent many children to the United States, such as South Korea and China, the stigma against domestic adoption is lifting. As more healthy children are being adopted closer to home, it is more often the children with disabilities who are available for adoption outside national borders, said Dr. Lisa Albers Prock, director of the Adoption Program at Children’s Hospital Boston, citing anecdotal reports in the past year.

“That tells me that the children who are coming to adoption internationally will be those children where someone had a concern earlier or where the child is known to have ‘special needs,’ ” she said.

Children with serious problems may, in some ways, be the lucky ones, said Dr. Laurie Miller of the Floating Hospital for Children at Tufts Medical Center. Children who need help eating, for example, may get extra time wrapped in an adult’s arms. Or a heart condition may warrant more careful attention, depending on the medical standards of the country.

The children left to languish for years in orphanages are clearly damaged by the experience, regardless of how wonderful their adoptive parents may be, research shows. Orphanages are still the dominant form of care in three-quarters of the countries from which children are adopted into American families, including China and Russia, the two biggest countries of origin for internationally adopted US children.

“The longer kids stay in that setting, the worse the effects on them and the more challenging it will be to bring them back to a normal trajectory,” said Charles A. Nelson of Harvard Medical School and Children’s Hospital, who has studied Romanian orphans since the late 1990s.

Fever’s trips to meet her sons had prepared her for the stark life of state institutions, but she was frightened for the listless little girl, later named Elsa, who weighed 12 pounds at 14 months old.

“She would just lay there. She could barely cry, she couldn’t laugh or smile,” Fever said. “We were so worried she was going do die. And children do die in these orphanages.”

Elsa lived. After months of high-calorie meals, frequent doctors’ visits, and early intervention services to encourage her development, she joined her brothers in January at a Montessori school. In the fall she will transfer to a public school that will offer occupational and physical therapy.

She’s thriving, but she’s also getting a brain MRI soon to determine if her habit of not using her heels to walk is rooted in a neurological problem or shortened muscles that can be corrected by surgery. Her winsome voice doesn’t match her more mature vocabulary, any more than her tiny size, which has her just clinging to the bottom of growth charts, fits her age. And still wearing diapers is a concern, her mother says.

“Pull-Ups,” Elsa corrects her.

Fever smiles, and challenges anyone to predict how well any child will fare.

“If you give birth, it’s a crap shoot [too],” she said “Look at her now. Don’t underestimate her.”

Specialists who follow adoptions found some differences between children adopted internationally and those adopted from within the United States.

A study of mental heath among American adolescents adopted under age 2 found that most of them were psychologically healthy, but they were at increased risk. Internationally adopted adolescents were more likely to be anxious or depressed than their non-adopted peers, while domestically adopted young people were more likely to have behavioral disorders, University of Minnesota researchers reported. They also discovered that adopted children had a higher chance of seeing a mental health professional than other children, perhaps because their parents were more likely to seek help and had the means to do so.

Albers Prock and Miller each lead clinics devoted to medical and developmental issues among internationally adopted children. They warn prospective parents about the health problems children may have, from fetal alcohol syndrome to the parasitic and infectious diseases children may bring into their new homes.

“No child has all of these problems,” Miller tells parents. “Most children do well.”

Parents might be tempted to rely on health records from the birth country, but such information can be inaccurate, or misleading. Many physical conditions that are considered serious disabilities in other countries, such as a cleft palate or a congenital heart abnormality, can be readily helped in the United States.

“Some of these things we can really treat and make a huge difference in the life of a child,” Miller said.

Speech, occupational, or physical therapy can help children with learning difficulties and developmental delays, bringing them closer to their peers in school.

Even if disabilities linger, the child is still lucky, Albers Prock said.

“You need to understand that your child is doing better in your family than he or she otherwise would,” she tells adoptive parents.

Cheryl Fever is sure of that.

“It’s scary sometimes. You just worry,” she said. “You love them with all your heart and you wish they didn’t go through what they went through. All you can do is try to give them the best medical care that we can. And just try to work with what you have.”

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