(For more Reuters Special Reports, double-click on )
By Robin Respaut
NEW YORK, March 26 (Reuters) - Amanda Alexander always wanted to adopt. In 2008, when her adoption agency sent a picture of a Russian girl who was available, Amanda fell in love.
The girl was almost 2, and the agency warned that she had a "developmental and speech delay." Two years later, an American doctor also diagnosed the girl with fetal alcohol syndrome and severe attachment disorders.
Now 7 years old, Alexander says, the girl has attacked her mother and classmates and tried to cut out her tongue with scissors. In the last three years, she has been hospitalized nine times for psychiatric care.
The Alexanders sought help from schools, social workers and other parents. But they found there is little assistance available for parents of international adoptees, particularly when children have severe trauma and emotional problems.
Their situation reflects a quandary faced by adoptive parents across the United States. With high hopes and often at great expense, families have adopted needy boys and girls from orphanages overseas, only to realize after returning to America that the children have behavioral or psychiatric problems that hadn't been diagnosed or disclosed.
Many parents are unprepared to handle the problems. Their adoption agencies often won't help. And neither will the U.S. government. Amanda Alexander left a job in management to devote time to her daughter. The Alexanders traveled from Seattle to Virginia to meet specialists, amassed enormous medical bills and moved to a different state to get better care for her.
In September, a Reuters investigation revealed how some desperate parents have turned to Internet groups to seek new homes for children they regret adopting. [http://reut.rs/1erHH03 ] The practice is called "re-homing," and the online bulletin boards enable parents to advertise children and arrange custody transfers that bypass government oversight.
In response to the news agency's findings, state and federal lawmakers are seeking measures aimed at stopping re-homing, and Russia and other nations are calling on the United States to account for what has become of international adoptees. Since the late 1990s, Americans have adopted about 243,000 children from other countries, but no authority tracks what happens after those children arrive in the United States.
The Alexanders say giving their daughter to a stranger they met online would have been unthinkable. "It's not something that we would ever do," Amanda Alexander says.
But for parents who hold onto a troubled international adoptee, the way ahead can be grueling. Reuters interviewed about two dozen families with troubled children adopted abroad. They described how their children molested siblings, tried to crash their cars, pulled knives on them, killed or tortured animals, or took weapons to school. Many of the parents did not want their names to be published, in part because they say they worry about stigmatizing their families.
Amanda Alexander, 34, decided to speak publicly. "It has been really hard," she says. "It's completely changed our lives in every way."
'LEAP OF FAITH'
In 2008, the Alexanders made three trips to Russia. There, eight doctors evaluated the parents-in-waiting to see if they would be fitting caretakers. The Russian physicians listened to their hearts with stethoscopes, inquired about drug and alcohol use, even asked about their greatest fears. The exam seemed somewhat staged to the Alexanders, who say the doctors asked them to pay $800 each for the service. They obliged.
The trips were required to complete the adoption. On each journey, the Alexanders learned a little more about the toddler they hoped to take home. On the second visit to Russia, they recall learning that the girl had a heart condition; on the third, they discovered she also had been diagnosed with cerebral palsy.
Amanda Alexander says she requested all of the girl's Russian medical records but was told by the adoption agency, European Adoption Consultants, Inc. that she would receive them on the final trip to Russia. When she did get the records, they were in Russian and contained references to conditions including cerebral palsy and a heart issue that were not mentioned in the English paperwork that the Alexanders had initially received.
An attorney representing European Adoption Consultants, citing confidentiality agreements, said the agency could not comment on specific cases but that parents typically receive the full medical information from orphanages earlier in the adoption process.
After the family brought their daughter to her new home in Tennessee, the family took the girl for a battery of tests by American doctors. They discovered her heart condition was a benign murmur, and the cerebral palsy was mild. But the girl's behavior was odd. She was hyperactive and would hit her head against her crib.
Doctors initially diagnosed her with ADHD. It would be another two years before Amanda learned that the girl had all the characteristics of fetal alcohol syndrome, along with child trauma and severe attachment disorders.
The Ohio-based adoption agency also offered no training and little information about the possibility of attachment issues, stating only that these were rare, the Alexanders say. Instead, the agency offered advice about travelling to the Moscow airport and how to declare money. The couple says they took it upon themselves to buy and read adoption and parenting books to prepare.
The executive director of European Adoption Consultants, Margaret Cole, said that training is part of the homestudy requirements, and the training includes "all the elements of parenting and adopting." Cole did not respond to further requests to comment.
International standards recommend - and will soon require -- that adoption agencies provide 10 hours of training for parents seeking to adopt overseas. That's not nearly enough, parents and adoption experts say.
The Alexanders say they would have proceeded with the adoption if they had known more about their daughter's eventual diagnoses, but would have prepared differently.
"I took a leap of faith and said, 'I want her,'" Amanda Alexander says. "She was meant to be ours."
SWEET BUT VIOLENT
When the girl was age 4, the Alexanders placed her in a pre-kindergarten program. She received private speech and language tutoring, but the school determined she was not eligible for a specialized program.
The girl was volatile. She could be sweet and spunky, then become physically destructive without warning. She attacked other students at school. Doctors prescribed medicine. Still, Amanda regularly received frantic calls at work about the girl's behavior.
When the girl threatened to kill a classmate, her pediatrician recommended a psychiatric hospital. It would be the girl's first of nine hospitalizations in the next three years.
With each psychiatric stay, the girl's medications would be tweaked to stabilize her mood, with limited effect. Once, she hit her mother in the head, sending her to the emergency room. Amanda quit her job in management at a government-owned electric utility to stay with her.
After school, the girl would sometimes try to bolt in front of cars or sit screaming in the parking lot before Amanda could get her home. Medical records show the girl poked herself with safety pins, hit herself in the stomach, and spread feces on herself and on her bedroom walls. She told doctors that she saw big black monsters in her room, and giggled as she talked about it.
Throughout this, the Alexanders' relationship with their adoption agency deteriorated.
At first, the family happily sent the agency pictures of their daughter, attended an adoption reunion, and spoke with waiting parents about their experience.
As the girl's behavior became more difficult to manage, the agency's social worker suggested the Alexanders wait for their daughter to adjust and recommended parenting books, Amanda says.
"It wasn't that we were being impatient in waiting for her to adjust," Alexander says. "We had read those books before we adopted. They hadn't helped us."
The Alexanders estimated they paid approximately $60,000 to adopt the girl, including travel to Russia and documentation expenses. Three years after the adoption was completed, the family asked the agency to help cover the girl's medical expenses. The Alexanders say the agency's director responded by offering to throw a bake sale.
European Adoption Consultants director Cole did not respond to requests for comment.
A lack of post-adoption support by adoption agencies is common, says Julie Beem, executive director of Attachment & Trauma Network Inc, a parent-led organization that supports families of traumatized children. "There is not a lot of post-adoptive follow-up that happens," she says. "If there is, it's passing a report to the sending countries. It's often very formalized and perfunctory."
One solution would be for the State Department to require accredited agencies to give families access to a mental health professional who is experienced at handling adoptions, says Kathleen Strottman, executive director of the Congressional Coalition on Adoption Institute, a Washington-based non-profit.
By the time the Alexanders' daughter was 6, she had gone through four schools. Her kindergarten teacher was afraid she would hurt other students. At home, the girl's behavior strained the Alexanders' marriage and their finances. Even with comprehensive private insurance, the family racked up almost $80,000 in 2011 alone in uncovered medical costs for the girl, Alexander says.
Last spring, a hospital discharged the girl from its psychiatric ward. The family was still in the parking lot when she told her parents she wanted to kill them with a knife. The hospital recommended that the Alexanders find the girl long-term psychiatric residential care.
In a letter outlining why the girl should be admitted to residential treatment, her therapist wrote, "In spite of all of the often insurmountable problems this family is experiencing, they continue to love [their daughter] and attempt to do what is best for her. This family is not living their life, they are merely existing."
Residential treatment can cost upwards of $250,000 a year, an expense not typically covered by private insurance. In the foster-care system, which handles children born in the United States, adoptees are enrolled in Medicaid and often are awarded subsidies to help pay for treatments. Internationally adopted children usually aren't covered by these safeguards.
"Families don't know where to turn," said Melanie Chung-Sherman, an adoption consultant in Texas. Child psychologists and counselors are abundant, she says, but it can be difficult to find specialists in adoption issues such as child trauma, fetal alcohol syndrome, and attachment disorders.
The Supporting Adoptive Families Act, proposed by U.S. Sen. Amy Klobuchar (D-Minn.), would boost assistance for adoptive families through training, counseling, and parent groups. States would be encouraged to beef up adoption support programs through existing funds.
In summer 2012, the Alexanders moved from Tennessee to Georgia. There, they applied for a special state program that allowed the Alexanders to bypass Medicaid income restrictions and enroll their daughter based on her disability. The program, called the Katie Beckett Waiver, is designed to allow families to provide home-based care for their disabled children.
The following year, they placed their daughter in a residential treatment facility near Atlanta for five months.
Since returning from treatment in November, the Alexanders say, the girl is calmer. She still rages when she comes home from school, but her behavior is more manageable.
The family also hired a lawyer to convince the school district to place their daughter in a specialized classroom. Amanda works two jobs from home to help ease the financial burden on the family.
This month, the Alexanders joined their daughter at a weeklong camp that specializes in helping children cope with attachment issues.
"She's worth it. She is just a little girl. She didn't ask for any of this," says Amanda. "She has so much potential. She just needs to heal, so she can reach it." (Reporting By Robin Respaut. Editing by Blake Morrison)