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The East: Adopted Children Need Extra Attention

Washington, 17 September 1997 (RFE/RL) - Children adopted from orphanages in Russia and other former Soviet republics might need extra attention in their new homes because they may have physical and psychological development problems, some U.S. researchers say.

The study of medical records of children adopted by parents in the United States attributes the developmental problems to spending months or even years in state-run orphanages.

The study is published in this week's edition of the "Journal of the American Medical Association." It was conducted by pediatricians Laurie Miller and Lisa Albers and several colleagues at the Tufts-New England Medical Center in Boston in the northeastern United States.

While the authors concluded that adopted children may be physically and emotionally behind other children in their age group, they also found that the adopted children were not suffering from the severe neurological impairments reported on their orphanage records. The U.S. doctors said the diagnoses of neurological damage made by doctors in the country of birth before the children were adopted generally turned out to be wrong,

The study evaluated 56 children adopted from the former Soviet Union and Eastern Europe between 1991 and 1995. Medical reports compiled before adoption were available for 47 children. These reports were compared with medical examinations made after adoption.

A total of 36 of the children studied were from Russia, seven were from Moldova, five came from Ukraine and one child came from Kazakhstan. In addition, the researchers studied the reports of four children from Albania and one each from Bulgaria, Latvia and Poland.

According to the researchers, 43 of the children whose reports were reviewed were classified in their birth countries as having multiple and unfamiliar neurologic diagnoses. These children ranged in age from two months to nine years, and the median age was two years.

"While serious medical problems were found or corroborated in 11 of the 56 children evaluated in our clinics, neurologic diagnoses cited in preadoptive medical reports was not confirmed," the doctors said.

Some of the mistaken reports on the adopted children may have been due to differences in diagnostic terminology and methods used in the former communist countries and the United States.

Dr. Miller told RFE/RL that: "there is an enormous discrepancy from country to country, program to program and even institution to institution within the same small geographic area in the kind of information that is available of the children who are being offered for adoption."

She said it poses a problem for adoptive parents, doctors and agencies that handle international adoptions, "to identify kids with problems because the amount of information is so variable, and in some sense the quality of that information that's provided to the parents is variable as well."

Among the disorders cited in the medical records from the countries of the children's birth were water on the brain and brain damage from pressure inside the skull.

Developmentally, the study said many of the adopted children lagged behind others in their age group. According to the report, 82 percent were behind in developing fine motor skills -- such as the ability to pick up small objects with the fingers and thumb; 70 percent were slow in developing gross motor skills -- which are skills involving movement of large muscle groups; 59 percent were behind in language development, and 53 percent lagged in social and emotional development.

The study said that, "children had one month of linear growth lag for every five months in an orphanage."

"Because of the growth and developmental delays in these children, we suggest that children coming from these environments should be considered -- at least temporarily -- 'special needs' children," wrote the researchers.

That means, said the report, that parents and physicians plan to provide a period of intensive rehabilitation to help the children catch up.

The U.S. pediatricians suggest a thorough medical evaluation for adopted children once they have reached their new homes because, "additional, important unsuspected diagnoses may be found." They also said that none of the children had been adequately vaccinated according to World Health Organization recommendations against common childhood diseases.

In 1996, American parents adopted 11,340 children from foreign countries. That is more than twice as many international adoptions recorded 20 years ago. The former Soviet Union and Eastern Europe accounted for 32 percent of international adoptions and many of these children were older at the time of adoption and had "resided in state-run institutions for months to years before placement.

Dr. Miller told RFE/RL that parents in adopting countries must be told of the differences in medical reporting that exist in the region and within the individual countries. She also said that work needs to be done to establish a single set of international standards for adoption. She said the International Pediatric Association is studying the issue.

Miller said, "these are kids for whom there are very few voices in the international community."