Zachary Helgestad is the kind of kid you just want to pick up and squeeze. Four years old, with blond hair, blue eyes, and a broad grin, he looks like a stereotypical Midwestern boy. But appearances can be deceiving.
His mother, Lisa, has already discussed with him the need not to hug or touch the stranger visiting their Otsego home, a tendency that psychologists term indiscriminate friendliness. “Kisses are for moms and dads,” she explains. As the visit progresses, Zachary calls for his mother to play. He wants to go downstairs. He wants to show the visitor a toy.
To the untrained eye, his behavior seems like nothing more than the curiosity and attention-seeking that one might see in any pre-schooler. But to experts, it’s clear that Zachary’s happy exterior masks serious challenges, problems which stem from his years in a place much less loving than his current home. Until Chris and Lisa Helgestad adopted him last year, Zachary lived in an orphanage in Nikolaev, Ukraine.
Turning the pages of a photo album, he points out scenes from that place, called the Baby House. It looks unremarkable—like a dormitory, with 12 to 14 small beds in each room. The rooms appear clean and orderly. Too orderly, says Lisa, recalling her visit to Ukraine: “I rarely saw toys out.” At the Baby House, a variety of workers care for the children. Life is so routine that the kids receive limited sensory stimulation. “They never saw any part of the world beyond the gates of the orphanage,” Lisa says.
Zachary is one of thousands of children who have been adopted from orphanages in Eastern European countries since the fall of communism in the 1980s. But unlike foster care, orphanages often have a profound effect on a child’s physical and psychological development. The results can include attachment disorders, learning disabilities, and difficulty with impulse control.
The Helgestads knew that helping an adopted child adjust to a new home would require patience and understanding. And as the parents of a biological son, Nicholas, they already knew the stress and sleeplessness of bringing home a new baby. What’s more, with degrees in child development, they felt equipped to surmount any parenting obstacle. But even the Helgestads didn’t anticipate the extent of the challenge. “We didn’t know what we didn’t know,” Lisa says. “When we first came home, even the basics—eating, sleeping, bathing—became a battle. It was impossible to comfort him. It was horrible.”
Seeking help, the Helgestads turned to the University of Minnesota’s International Adoption Clinic. Founded 25 years ago, the IAC was the first center of its kind in the United States and helped establish the field of adoption medicine as a whole new subspecialty in pediatrics. The IAC has become a model for other clinics around the country, garnering an international reputation, and, through extensive research, has created a greater understanding of the special medical and developmental needs of internationally adopted children.
Even before adopting, a family may send medical information about a child to the clinic for assessment. The IAC staff conducts roughly 1,000 assessments annually and sees 300 to 400 children in the clinic each year. “Because medical reports can be misleading and confusing it’s important to have the expertise to view them in the context of each child’s country of origin,” says Cynthia Howard, the clinic’s director. For example, children in Ethiopia are at risk for infectious diseases such as malaria and tuberculosis, while in China lead poisoning may be a problem. It’s difficult for primary-care providers in the United States to know the health risks in every region, but the IAC is familiar with the health issues unique to children in particular parts of the world. “In many areas, it’s not uncommon for us to know the orphanage and the medical staff personally,” Howard says.
At the clinic, children such as Zachary receive baseline screening to address any immediate physical problems as well as long-term cognitive and attachment concerns. Depending on the child’s needs, the clinic draws on the U’s expertise across the medical spectrum—from ophthalmology to occupational therapy—and coordinates the child’s care among all of these specialties.
The Helgestads learned that Zachary’s immunizations were not effective; he had to be completely revaccinated. They also met with child psychologist Maria Kroupina, a professor with the University of Minnesota’s Department of Pediatrics. An expert on attachment disorders, Kroupina explained Zachary’s behavior to them in the context of his life at the Baby House and offered strategies to begin to overcome the deficiencies of his early environment. “Parents need help as much as the children,” she says.
Kroupina suggested ways to strengthen Zachary’s bond with his new parents. She prescribed a routine in which only Chris and Lisa provided all basic care in order to establish a healthy attachment (no babysitters could relieve these frazzled parents). She also addressed a related problem—the child didn’t grasp the hierarchy of personal relationships. He offered hugs and kisses to his new parents and strangers alike, and he would climb into almost anyone’s lap. “Everyone enjoys a child who is outgoing and friendly,” Kroupina says, “but children must learn boundaries, different behaviors with different people, and physical contact that’s appropriate.” So, Zachary’s physical contact with other people was limited to Chris and Lisa, which was effective, but frustrating to members of the Helgestad’s extended family, who were eager to shower Zachary with hugs and affection.
International adoptions haven’t always posed such complex problems. In 1986, when the clinic was founded, Americans were adopting about 8,000 children internationally a year. Most of these were babies from Korea, where orphaned or unwanted children lived in foster homes, received individual attention, and were adopted at an early age. While they rarely experienced the developmental problems that challenge institutionalized children, these adoptees did face health problems that were unfamiliar to American pediatricians. “At that time,” says Dana Johnson, co-founder of the IAC, “primary-care physicians didn’t screen patients for third-world diseases. Most of these children were adopted by well-to-do parents, so they arrived at their pediatricians’ offices dressed beautifully, looking great. But the prosperous façade hid the fact that 60 percent of the children had something—TB or hepatitis, for example.”
When children began arriving here from Eastern European orphanages, the focus of adoption medicine changed abruptly. These children brought with them new and puzzling problems that were seldom encountered in adoptees from countries where foster homes were the tradition. The European children showed aggressive or overly passive behavior, attachment-bonding problems, developmental delays, language disorders, inability to give or receive affection, and oversensitivity to touch and other stimulation.
The lives of these children have provided physicians and researchers with a window into what Megan Gunnar, director of the University of Minnesota’s Institute of Child Development, calls “the complex story of human development and early adversity” as never before. Says Dana Johnson, “We always knew that families were important, but we didn’t know just how important.”
Deprived environments such as orphanages bring more than mental-health issues. As our understanding of genetics becomes more sophisticated, researchers have begun to dispel the idea that genes are unchangeable and that genes alone determine development. Instead, they have found that early experience affects the activity of genes. Negative experiences, such as high levels of stress or deprivation, leave a chemical “signature” on genes that may be temporary or permanent. These chemicals don’t change the DNA, but they do influence how genes are turned on and off and even whether some are expressed at all. Says Gunnar, “Without a supportive set of close, responsive relationships during infancy and early childhood, it is not just our sense of self that can get derailed. Numerous aspects of brain development are disturbed.”
At the same time, says Gunnar, researchers are learning more about how to undo the damage. Studies are showing that the human organism is remarkably resilient, she says, and given the proper medical and psychological support amid a loving family, most children adopted from orphanages can catch up and do very well. “They may not achieve what they could have achieved if they had a supportive home from the beginning, but they do very well,” she says.
The research is paying off for Zachary. The eating, sleeping, and bathing issues are under control. He’s far less anxious and demonstrates his attachment to his mother as he frequently leans against her and asks questions. “But the more comfortable he feels, and the better his language skills, the more he challenges me,” Lisa says with a laugh. “I think he tests the waters more than any other four-year-old.”
Structure is especially important for Zachary. Because he came from an environment with little variety or stimulation, he becomes overwhelmed and feels frantic when he faces too many choices. Self-control is still an issue, and the Helgestads are investigating the causes of his balance and coordination issues. They return to the IAC every three to four months. “On our last visit, Dr. Kroupina said we should consider the last year a success,” Lisa reports. “Without the clinic, we’d be going down a very different path.”
“With the right intervention, we can reverse the trajectory,” says Kroupina. “You can see each child bloom like a flower slowly opening.”
Terri Peterson Smith is an Edina-based freelancer.