Past Traumas Afflict Many Former East Bloc Orphans

Sara was 22 months old and like a child in shock when an American couple adopted her and brought her home from a Romanian orphanage in 1991. She couldn’t walk or talk, and she would not eat solid food, not even dry cereal.

She would rock and bang her head or just stare, her tongue hanging out, her dark eyes wide with unspoken fears. She suffered night terrors and tore her room apart. She tested at the developmental level of a 6-month-old.

“For the first two years, I didn’t get any sleep,” recalled her mother, Lily Romine of Lakeland, Fla. “It was a very difficult time.”

Romine’s experience with Sara has been repeated nationwide by many families who have turned to the former Soviet Union and its satellite nations in Eastern Europe in recent years to adopt children.

To be sure, many of the estimated 10,000 children who have arrived here from the former East Bloc since 1990 have adjusted easily to their new lives. But a large number, particularly those old enough to have spent several years in orphanages, is showing the effects of years of physical, social and emotional deprivation.

In addition to predictable physical health problems--malnutrition, gastrointestinal ailments and infectious diseases such as hepatitis B--the children also bring a host of developmental and behavioral disorders, from mild to severe. These can include speech and language delays, motor problems and difficulties forming attachments to family members.

“In general, the longer . . . a child is in an orphanage, the more the cognitive abilities decrease and the greater the risk,” said Sharon Cermak, a Boston University professor of occupational therapy who has made several trips to Romanian orphanages to study the children.

Some adopting families, ill-equipped to cope, have given up their children, a process known as “disruption.” Others have filed suit against their adoption agencies, asserting they were not warned about what to expect.

Although the problems associated with institutionalization are not new, “we have had this absolute explosion in agencies involved in international adoption who come to this with no historical background and no appreciation of the issues involved,” said Clyde Tolley, executive director of Families Adopting Children Everywhere, a Maryland-based support and education organization for adoptive families.

Many agencies are only just now beginning to prepare parents for the kinds of difficulties they may face with many of these children. Others still play down the problems, fearful of scaring off prospective parents.

As a result, “many [families] who adopt older kids are not aware of these issues,” Tolley said. “Most adoptions work, but a hell of a lot don’t. And there appear to be more disruptions now than ever before.”

‘Major Life Decision’

Most parents, however, are determined to stay with it once their children are home, regardless of the challenges.

The possibility of such problems “is just one factor in what is a very complex, personal and major life decision,” said Deborah Hopkinson of Walla Walla, Wash., mother of 10-year-old Dimitri, adopted four years ago from a small town about two hours north of Moscow.

“If you wake up in the middle of the night and start thinking about this child, and that thinking doesn’t go away, then probably you will do it [adopt], no matter what failure or success stories you hear.”

What’s important is “his success, taking into consideration what he has been through and who he is,” she added. “Your job as a parent becomes fighting for that success . . . whatever it takes. Yes, my son’s problems make our lives harder and more stressful, but his life has already been 10 times harder than mine ever was, and the person who suffers most is him.”

Thus, the post-adoption roller coaster has propelled most families into searching for the right kind of help for their children. And help is available once the source of the problems is understood.

This is not always the case. Schools, day-care centers and pediatricians often shrug off the behaviors or misdiagnose them. And once parents find the right support, they often must battle their health insurers for coverage.

Insurers often label the problems developmental delays. While many are developmental in nature, many children will not overcome them without intervention.

“I think so many of us are told, ‘They’re just a little bit behind. If you give them love and care and are patient, they’ll catch up,’ ” said Romine, a former preschool teacher who researched the types of special therapy available and delivered it herself to Sara, now 6 and thriving in kindergarten. “The truth is that’s not enough. You also have to undo the damage.”

It’s no wonder that such damage occurs. In Romanian orphanages such as Sara’s, for example, children often had nothing to do but lie in cribs all day. No one ever held them. They had no toys to play with. Their food, even when they were toddlers, came from bottles.

Even in Russia, where orphanage care is regarded as good, children receive little sensory stimulation or affection. Toys are scarce. One 3-year-old boy, after arriving in the West, wept and trembled at his first sight of a playground.

Most parents do not realize that the absence of the things they do naturally--cradling their babies, kissing them, tickling them, showing them how to shake a rattle or cuddle a teddy bear--can devastate a child’s developing brain.

At Bucharest’s Orphanage No. 1, considered the showplace of the Romanian institutions, Cermak found the facilities scrupulously clean. But “there was no stimulation of the children at all.”

“There were no toys. The children stayed in their cribs. There was one playpen in the center of the room into which they put multiple kids. There was very, very little holding or touching. There was one caregiver to every 15 children.”

Rejecting a Touch

Cermak, who evaluated many of these children, most of them ages 1 and 2, said they demonstrated “a tremendous amount of sensory defensiveness: pulling away from touch, not just people touch but toy touch. They found everything very uncomfortable.”

Sensory integration dysfunction is a condition in which the brain cannot properly process information received through the senses. Many professionals regard sensory integration dysfunction as neurological, but the environment can heavily influence whether a child will experience problems.

Some children with this syndrome cannot tolerate touch and react defensively to certain textures, particularly in food and clothing.

Others display the opposite extreme: Known as “crashers,” they crave touch. They bump into things, throw themselves on the floor and often cannot keep their hands to themselves. They flick buttons and light switches constantly; they often break things because they do not know their own strength.

Many children with sensory integration dysfunction are restless and have difficulty with posture and balance. Often they overreact to noises.

For months after his arrival, a Russian boy covered his ears when he heard a toilet flush. A Romanian girl refused to wear clothes until the labels were removed.

Sensory integration dysfunction is treated with an occupational therapy regimen that experts speculate reteaches the brain the right way to use sensory information. Gains are often steady, but the process can take several sessions weekly for a year or more.

Teachers and other school personnel often confuse sensory integration dysfunction and other effects of institutionalization with attention deficit disorder and urge parents to consider medication, such as Ritalin.

While some of these children may actually have attention deficit disorder, many of the problems are misdiagnosed, Cermak and others say. Most experts recommend that parents wait before having their children screened for ADD, particularly if they are 5 or younger.

Food Phobias

Food also can create major problems for unsuspecting families.

“Many of these children won’t let spoons come near their faces, and they spit everything out,” Cermak said. “They had never eaten solid food. Caregivers would mush it up and put it in bottles, even for older kids.”

Sara Romine would not eat solid food until she was 4; all her meals had to be liquefied in a blender. She also did not walk until she was 2. She screamed when anyone tried to wash her face or help her blow her nose. She did not speak until she was nearly 5.

Sara, like many such children, showed indiscriminate affection to strangers. In addition to being dangerous--many parents worry that their children will simply walk off with anyone--this tendency is a sign of attachment disorder, the inability to bond with a parent. It results from having multiple caregivers during the early years.

Children with attachment disorder are often superficially charming and fail to make eye contact. Control is a big issue; they always want to be the boss. Many lie or show no conscience. Others display abnormal speech patterns, learning lags and a preoccupation with cruel, destructive or violent behavior.

“When we’d go out in public, Sergei would just crawl into the laps of strangers,” said Laurie Holtz, a medical technologist from Seattle. She and her husband recently adopted Sergei, 3, from Georgia. They also have a biological son and a daughter from Russia.

After some months, his mother says, Sergei has become “a completely different child,” able to trust a single primary caregiver. In general, younger children can overcome attachment disorder more easily than older ones.

It can be more difficult with some older children. Deborah Hopkinson says she and her husband and their 12-year-old biological daughter have had a tough time with Dimitri, who was 6 when he was adopted. He had been in an orphanage since he was 7 days old.

He has been disruptive in school, throwing books off the shelves and overturning furniture, and has had a hard time making friends.

“He wants to be the boss because he always was the boss before,” Hopkinson said. “He doesn’t realize that he doesn’t have to be the boss anymore.”

Dimitri has improved, but his family still does not feel completely confident about his future.

“What I worry about is adolescence,” his mother said. “The hardest part for me is this fear that he won’t be able to get it together, that it won’t turn out OK. And nobody can tell you that it will--or will not.”

Most families are determined to find solutions for their children.

“I never considered disruption,” said Lily Romine. “I never felt like I had to give up. I always felt I would find an answer” for Sara.

She found it from occupational therapists and speech therapists who worked with Sara on her own level. “A speech therapist advised me to start talking to her in one-word sentences, and then, after she was using one-word sentences, to talk to her in two-word sentences. Like, ‘More food.’ That’s how she learned how to talk.”

Today, at 6, Sara is thriving.

“She’s doing great. She’s very social. Other children love her, and she loves them. She’s a wonderful, happy little girl who’s getting along just fine at school, learning how to read. The teacher says she’s the best listener. I don’t think there’s a little girl anywhere who tries harder than Sara.”