Helping Families With Russian Adoptees

Abstract

With the increase in children adopted from Russia, family therapists in the United States face the dilemma of helping adoptive families care for their child and build a healthy family unit. This article familiarizes family therapists with children’s unique experiences in Russian institutionalized care and its impact on children’s social–emotional development, behavior, and attachment patterns. Implications for family therapists working with families adopting Russian orphans are discussed.

Keywords

Russian orphans institutionalized care social–emotional development attachment family therapy

In April, 2010, the case of a 7-year-old Russian orphan, Artyem Saviliev, made international headlines: The boy had been abandoned by his adoptive American family seven months after his arrival at his new home. The boy’s adoptive mother, Ms. Hansen, sent Artyem to Russia as an unaccompanied minor with a note pinned to his jacket, stating her decision to terminate her adoption rights due to the child’s mental instability and dangerousness. In her defense, Ms. Hansen stated: “This child is mentally unstable. He is violent and has severe psychopathic issues/behaviors. I was lied to and misled by the Russian Orphanage workers and director regarding his mental stability and other issues” (Stewart, 2010). Despite a strong reaction from American and Russian societies toward Ms. Hansen’s action, the case of Artyem Saviliev raised concerns related to international adoption issues, adoptive families’ awareness of Russian orphans’ unique needs and experiences, and these families’ ability to respond and care for their adopted children.

Indeed, there is evidence that adoptive parents challenged by Russian adoptees behavioral problems and emotional instability to often engage in parenting characterized by abuse and neglect. For example, in the past decade, of the 20 fatal cases of parental abuse and neglect of internationally adopted children, 16 children were from Russia (McGuinness & Robinson, 2011). These numbers are alarming and indicate that families adopting Russian orphans often need extra support and mental health interventions to prevent abusive parent–child relationships and empower parents to deal with their children’s unique needs and challenges. Therefore, family therapists working with families adopting children from Russia need to understand unique experiences and social–emotional needs of Russian orphans to help increase healthy functioning in the adoptive family system. The purpose of this article is to describe Russian institutionalized care and its effects on children’s development, attachment patterns, social–emotional and behavior problems, and academic skills. Family therapists may find this information to be helpful in planning their treatment and in securing necessary resources for American families with Russian adopted children.

Background on Russian Adoption

According to the U.S. Department of State (2009), nearly 300,000 children have been internationally adopted in the past 20 years. The majority of internationally adopted children come from China, Ethiopia, and Russia. In 2010 alone, 1,082 Russian orphans have joined American families (U.S. Department of State, 2010). Despite the high adoption rate, more than 260,000 Russian orphans continue to live in institutionalized care. The majority of these children are characterized as social orphans, meaning they lost their caregivers either through abandonment or termination of parental rights by the court (Prisiazhnaia, 2008).

Providing children for international adoption is a relatively new phenomenon for Russia. During the Soviet Union era, Russian orphans were provided social protection from the government, and their adoption was limited to Soviet families. However, demolition of the Soviet Union in the late 80s to early 90s and the concomitant economic and societal crises resulted in rising poverty and depression that led to a dramatic increase in alcoholism and substance abuse in Russian society. As a result, the numbers of social orphans has substantially increased (Prisiazhnaia, 2008), leading to the growth of institutionalized care. Currently, the main reasons for children to be placed into orphanages are parental behavioral (e.g., mental health problems and substance abuse) or financial inability to care for a child, parental unwillingness to raise a child with a disability, or removal of parental rights due to abuse and neglect (St. Petersburg-USA Orphanage Research Team, 2008). Because a negative stigma is attached to Russian parents who adopt children from institutions (Sobkin & Adamchuk, 2006), adoption by American families has been one of very few chances for Russian orphans to find a warm and loving home.

Adopting children from Russia often offers several advantages for American families over domestic adoption, including time efficiency, lower costs, closed adoption processes, easier adoption processes, and the opportunity to adopt Caucasian infants and young children. Indeed, domestically adopting a Caucasian infant may be a challenging task, especially if the prospective parents are either homosexual or older (Linville & Lyness, 2007). Russian adoptive agencies do not restrict adoption because of parental age or family composition, which automatically makes the adoption process quicker and easier for American families. Although Russian orphans were among leading choices for internationally adopting parents in the past decade (U.S. Department of State, 2009), adoptive families continue to feel unprepared for unique challenges in caring for these children. The adoptive parents’ limited knowledge of children’s experiences in institutionalized care prior to adoption and its effects on their social–emotional development and attachment patterns further exacerbate the challenge (McGuinness & Robinson, 2011; Purvis, Cross, & Sunshine, 2007).

Children’s Experiences in Institutionalized Care

Substantial attention has been given to the effects of the early relational experiences of infants with their caregivers, especially in terms of children’s physiological and social–emotional development (Bowlby, 1980; Merz & McCall, 2011; Schore, 2005). Because the majority of Russian adoptees are born to economically and socially disadvantaged families (Tirella et al., 2007), these children often face several risk factors impeding and interrupting their development, including prematurity, low birth weight, inadequate prenatal care, and prenatal exposure to maternal stress and substance abuse (Miller et al., 2006). A combination of these risk factors and institutionalized care characterized with low stimulation and caregiver availability, malnutrition, and stress often result in postnatal growth retardation, cognitive and language delays, and neurobehavioral problems (Miller et al., 2006; Tirella et al., 2007).

Several researchers have raised concerns on children’s experiences in institutions. Russian institutions vary in the availability of resources to meet children’s basic physiological needs: sanitation, nutrition, and medical care (St. Petersburg-USA Orphanage Research Team, 2005). However, psychosocial deprivation appears to be a consistently grave concern for all institutionalized children in Russia. Muhamedrahimov (1999) reported that infants received less than 12 min of adult interaction during each 3-hr span of observation of their waking time. The quality of these interactions was limited to activities of daily living with limited social interaction and language communication.

Tirella et al. (2007) also investigated early social and caretaking experiences of children in early childhood institutionalized care for children between 0.0 and 4.0 years of age. Researchers observed 138 children during their active wake hours (8:00 a.m. to 1:00 p.m.) for 10-min intervals per child. The observations indicated that on average children spent half of their awake time alone (50%), with infants spending significantly more time alone (65%) when compared to toddlers (43%). Although infants received more one-on-one caregiver interaction (20.4%) when compared to toddlers (10.1%), the quality of these interactions was limited to activities of daily living with limited signs of affection, physical contact, and verbal interaction.

Therefore, both findings (Muhamedrahimov, 1999; Tirella et al., 2007) raise a concern that Russian orphans in their early years are deprived of the opportunity to experience a social–emotional connection. These findings are alarming because the quality of children’s psychosocial experiences can have a profound effect on children’s social and emotional development and attachment patterns, affecting their ability to build quality relationships and exhibit prosocial behaviors later in life.

Social and Emotional Development of Russian Orphans

Developmental theorists have recognized the importance of children’s early relationship experiences on their social and emotional development (Bowlby, 1980; Schore, 2005; Vygotsky, 1978). Previous research has indicated that early separation from caregivers can have adverse effects on children’s well-being (Bowlby, 1980, 1982). In particular, children raised in institutions with limited opportunity for interaction with concerned and responsive adults have been found to show severe socioemotional development problems (Zeanah, Smyke, Koga, Carlson, & The Bucharest Early Intervention Project Core Group, 2005). Indeed, Tirella et al. (2007) found that Russian orphans’ limited social interactions with caregivers seemed to have an effect on children’s patterns and frequencies of verbalizations. For example, observations indicated that children were silent nearly half of their awake time. However, if vocalization was occurring, it was 3 times more likely to be directed to self or a toy (21.6%) than to another child (7.4%) or adult (4.2%). Therefore, children who in their early years were deprived opportunities to develop language skills were found to have significant language and reading deficiencies (Hough & Kaczmarek, 2011) and academic problems (Purvis et al., 2007) later in life. The most generally held explanation for these findings is that disruptions to the parent–child attachment are so upsetting to children that they result in negative socioemotional outcomes ranging from mild to quite severe (Lawrence, Carlson, & Egeland, 2006).

Lack of social–emotional activities and relationship with caregivers and other children in Russian institutions has been linked to children’s developmental delays (St. Petersburg-USA Orphanage Research Team, 2005). The typical daily activity for the young child is limited to being alone in the crib with nearly half of the time not having any material object (e.g., bottles or toys) present for play, exploration, and stimulation. As a result, children do not learn to relate to each other, mostly play in isolation even when in groups, use toys in adult-prescribed manner, and do not tend to engage in creative, imaginary, and spontaneous play. Lack of relational and creative play has been linked to negative impact on child’s development of physical, cognitive, and social–emotional competencies (Scarlett, Naudeau, Salonius-Pasternak, & Pont, 2005; Vygotsky, 1978). When compared to U.S. noninstitutionalized children, nearly 90% of Russian orphans demonstrated significant developmental delays in cognition, adaptability, fine and gross motor skills, and communication and social skills. Children’s physical growth measured in height, weight, and head and chest circumference is also significantly delayed relative to Russian and U.S. standards. Nearly half of institutionalized Russian orphans were found to be below the 10th percentile for physical growth of U.S. standards (St. Petersburg-USA Orphanage Research Team, 2005). Such physical and developmental gaps continue to exacerbate in children as their length of stay in orphanages increase.

Russian orphans’ limited exposure to positive caregiver interaction (Tirella et al., 2007) has been found to have a negative effect on their ability to recognize social cues and boundaries and understand other people’s emotional experiences (Camras, Perlman, Fries, & Pollak, 2006; Rutter, 2002). Camras, Perlman, Fries, and Pollak (2006) asked postinstitutionalized and never-institutionalized children to perform two emotion-understanding tasks: match facial expressions to four emotional labels (happy, sad, angry, and scared) and match facial expressions to emotional connotations of presented stories. The findings indicated that postinstitutionalized Eastern European children performed significantly more poorly in emotion understanding tasks than postinstitutionalized Chinese children and never-institutionalized children. These findings are significant, because children’s ability to understand others’ feelings may negatively affect their ability to build empathic relationships with significant adults in their lives, have an understanding of the impact of their behavior on others, and learn to self-regulate their emotional needs (Schore, 1994, 2005). Schore’s (1994) work on attachment and the development and regulation of right brain, demonstrates the effects of mother–child interaction on the infant’s developing brain where emotional experience and expression are created, refined, and solidified. When the mother continuously fails to respond to the baby, the baby misses the connection with its mother, this misconnection resulting as an interruption in the formation of brain pathways that reflects the lack of nurturance. Indeed, a prolonged psychosocial deprivation in early years of life have been linked to limited attention span, externalizing behavioral problems, antisocial behaviors, social difficulties, and withdrawal in adopted children from Russia (Hawk & McCall, 2011; Merz & McCall, 2010; Schore, 1994; St. Petersburg-USA Orphanage Research Team, 2005). Researchers found that deficiencies in early childhood social experiences have a prolonged effect on children’s behavior even after postadoption and also become more noticeable or severe during adolescence (Hawk, & McCall, 2011; Merz & McCall, 2010).

Purvis, Cross, and Sunshine (2007) identified the following common problematic behaviors in adopted children: preoccupation with food, lack of empathy, self-comforting and repetitive physical behaviors, fearfulness, hyperactivity, manipulation and triangulation of family members, indiscriminate friendliness, high tolerance for pain, and hypersensitivity to certain stimuli. Although such behavioral problems stem from neurological impairment due to deprivation of early social–emotional experiences and possible trauma and can be easily triggered by any fearful stimuli to the child, parents struggle to understand and accept such behaviors in a child who seems to be physically developed by age (Purvis et al., 2007). Children exhibiting social, emotional, and behavioral developmental delays may also often have an attachment dysfunction further adding to the challenge for adoptive parents to bond with their adopted children and help them meet their social–emotional needs.

Development of Attachment Patterns in Russian Orphans

Children’s prolonged experiences in institutionalized care with little opportunity for interaction with warm and responsive caregivers have a negative impact on their developing attachment patterns. According to attachment theory, it is essential for a child to experience warm, caring, responsive, and supportive relationships with a stable caregiver early in life for optimal social–emotional development and mental health later in life (Bowlby, 1980; Schore, 2005). Such experiences are essential for children’s optimal brain development as well as children’s formation of a secure bond with a caregiver, development of their sense of worthiness and belonging, and ability of emotional self-regulation (Schore, 1994). Purvis et al. (2007) noted that sensory experiences with a caregiver are essential for the child’s formation of secure attachment patterns: “as parents and infants coo and smile at each other, the child’s brain begins to build the neurological pathways of learning and healthy social connections” (p. 25). Feeding, cuddling, holding, and rocking are examples of such sensory experiences that promote secure attachment development.

Children’s experiences in Russian institutionalized care have a long-lasting impact on their attachment development. First, children are deprived of opportunities to bond with a particular or single caregiver because of the high frequency of staff turnover. On average, in their first 2 years of life children can come into contact between 60 and 100 caregivers in orphanages (St. Petersburg-USA Orphanage Research Team, 2005). Furthermore, observations of child–caregiver interactions indicated a lack of warm, caring, and sensitive interactions and emotional expressiveness and responsiveness. This could be partially explained by caregivers’ self-perceived primary role as providers of medical care and education, unwillingness to form bonding relationships with children, and hectic work schedule due to high caregiver–child ratio (Muhamedrahimov, 1999).

Finally, children’s early relationship experiences with caregivers lack sensory stimulation that is essential for healthy development. For example, observations in Russian orphanages indicated that children were not held, kissed, or hugged. Furthermore, children were not held even during their feeding. Instead, their bottles were propped on pillows (St. Petersburg-USA Orphanage Research Team, 2005). Researchers concluded that observations of children’s lack of affect, disinterest in adults’ presence in their room, indiscriminate friendliness with strangers were the result of such prolonged social–emotional deprivation (St. Petersburg-USA Orphanage Research Team, 2008).

To care for children with an attachment dysfunction can pose a challenge for adoptive parents. Indeed, adoptive parents reported feeling unprepared to parent postinstitutionalized children (Purvis et al., 2007) and exhibited high levels of child–parent relationship stress (McGuinness & Robinson, 2011; Merz & McCall, 2010). Children with attachment dysfunction exhibit difficult and nonreinforcing behaviors that may cause parents feel rejected, incompetent, and failing. For parents, who prior to adoption, had to prove competency to care for the child, to later admit their need for help and thereafter seek assistance from family therapists can be embarrassing. Therefore, it is important for family therapists to recognize and understand unique struggles and needs of families with children adopted from Russia and provide sensitive services to all family members.

Implications for Family Therapists

As previously indicated, adoptive families may seek the help of family therapists for a variety of reasons, including children’s disruptive behavior, child–parent relationship stress, feelings of parental incompetence, and failure. However, children’s difficulty to securely attach to their adoptive parents appears to exacerbate the above problems and challenge families’ postadoption adaptation process. As Forbes and Post (2006) described, “after years of living with a child who is unable to reciprocate respect, affection, and love, parents go from being a lavish rainforest of love to an arid dry desert—hostile, angry, and depleted” (p. 31).

Linville and Lyness (2007) noted the importance for family therapists to integrate attachment theory in treating postadoptive family systems. Attachment-focused interventions should be aimed at both helping the child bond with the parents and helping parents address their attachment patterns that might be triggered by the defiant and aloof behavior of the postinstitutionalized child. Parents facing children with attachment disorders require better-than-average parenting skills to manage children’s behaviors, attune to their feelings and needs, and address their own parenting stress (Judge, 2004). Therefore, family therapy treatments should provide parents with opportunity to process their parenting challenges and attachment triggers that gets in the way of bonding with their children and learn effective parenting skills to manage children’s defiant behaviors, attune to children’s feelings and needs, and strengthen parent–child relationship (Carnes-Holt, 2012; Linville & Lyness, 2007; Purvis et al., 2007).

Family therapy interventions should also be responsive to children’s developmental needs. Play-based family interventions can be particularly effective with adoptive children from Russia who have delays in language development. In play-based interventions, children use toys as theirs words and play as their language (Landreth, 2012). Play-based interventions allow children to enact their worldview and experiences and help parents observe and understand their children’s emotional needs. Filial therapy is an example of play-based family therapy treatment that may be effective in working with adoptive families. Filial therapy aims at strengthening child–parent relationship, helping children feel trust and security in their relationship with parents, and empowers parents with effective parenting skills to meet their children’s social–emotional needs (Carnes-Holt, 2012; Landreth & Bratton, 2006). Strengthened parent–child relationship also leads to the improvement in child’s behavior and social–emotional development. The structure and format of the filial therapy treatment incorporates opportunity for parents to process their struggles with the family therapist, practice effective parenting and relationship-building skills with the child, and receive feedback on their child–parent interaction. Filial therapy can be conducted with one individual family or in a group format for families to receive additional support from each other. An outcome study with 61 adoptive parents indicated that filial therapy may be an effective treatment to reduce children’s behavior problems and parental stress and increase parental empathy and the quality of parent–child relationship (Carnes-Holt, 2012).

Theraplay, another attachment-focused play-based intervention that is often recommended for adoptive families (Theraplay Institute, 2010) trains parents to help their adopted children feel nurtured, safe, and worthy through the use of fun and playful activities. Each therapy session includes a balance of structure, engagement, challenge, and nurturing in an environment of therapeutic playfulness which eventually promotes healthy attachment. Through Theraplay, parents learn to attune to their children’s feelings and respond to them, resulting in strengthened parent–child relationship (Przybylo, 2008). As part of the Theraplay treatment, family therapists often use the Marschak Interaction Method tool to observe the quality of child–parent interaction for parental guidance and treatment planning. Although outcome research on Theraplay with adoptive families is lacking, reported case studies indicated improvement in quality of child–parent relationship and children’s behavior (Przybylo, 2008; Weir, 2007).

The care for an adopted child brings unique daily challenges to parents who have otherwise had previous parenting experience. In addition to family therapy interventions, family therapists can supply adoptive parents with psychoeducational resources to assist them in their daily parenting challenges. For example, Purvis et al. (2007) The Connected Child, a useful resource for parents, describes institutionalized children’s unique experiences and impact on child development and health, attachment-focused parenting skills and daily child–parent activities, and solutions for daily parenting challenges. Family therapists can also suggest attachment-focused psychoeducational children’s books to read with children before bedtime or engage in nurturing child–parent rituals during daily activities. Bailey’s (2000) I Love You Rituals provides numerous ideas for daily rituals and games to strengthen parent–child bonds and enhance children’s self-perception and cooperation.

Because adoptive parents indicated experiencing high stress related to decrease in support from families and friends after adopting children from Russia (Linville & Lyness, 2007), it may be important for family therapists to help adoptive families find support in their communities. For example, connecting parents to adoptive parents from their communities may help parents feel supported and encouraged. Facilitating support groups for adoptive parents will provide them with a safe place to share difficult experiences, normalize feelings of incompetence, failure, and rejection, share common experiences and stories, and ask for help and resources. Finally, adoptive families consistently report feeling unprepared to care for children adopted from Russia (Groza & Ileana, 1996; Purvis et al., 2007). Because institutionalized care differ in each country and have a different impact on a child (Camras et al., 2006), it is important for the adoptive family to understand the unique nature of institutionalized care in Russia and its possible effects on their child’s cognitive, language, and social–emotional development, attachment patterns, behavior, and academic readiness. Family therapists working with families adopting from Russia should consider developing collaborative relationships with adoption agencies and offer psychoeducational services to adoptive parents about Russian orphans’ unique needs. Preparing families for adoption and providing supportive services postadoption may help families feel better prepared to face difficulties for caring for an adopted child and prevent severe family dysfunction.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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