International Adoption Brings Unique Challenges and Blessings


Every year, thousands of U.S. citizens adopt children from overseas, providing homes to children in need of a forever family. International adoptions in the United States began in earnest after World War II. Countless children had been left orphaned or at risk and U.S. servicemen sent to Europe and Asia had left behind significant numbers of children in countries where they had been stationed. Some children were abandoned with the mother, while others never knew of the child’s existence. While there are no guarantees when having your own biological children or adopting domestically,  international adoption brings specific risks prospective parents should be prepared to face in order to provide a safe and loving home for a child.


Screen Shot 2017-05-17 at 7.53.15 PMLast year, nearly 4000 American families adopted internationally. Paul and Lisa Howard adopted their son Lucas from an orphanage in Baku, Azerbaijan in 2001. They are a military family and were stationed in Germany when they decided to start a family. After experiencing infertility issues, they decided to pursue adoption. Because they were stationed overseas, domestic adoption (an American child) was not possible, so they chose to adopt internationally. From the start of the process through bringing Lucas home, their journey took 18 months. During that time the United States experienced the 9/11 terror attacks, slowing everything down. As a result, Lucas spent his first year and a half of life in an orphanage, with a questionable level of care.

During the adoption process, the Howard’s conceived and Lisa gave birth to their daughter Madeline just weeks before Lucas came home. At 18 months, he weighed just 15 pounds. When they took him to their pediatrician, they had him assessed as though he were a newborn. The doctor discovered that Lucas was hypothyroid, meaning his body failed to produce enough thyroid hormone to support his body’s needs. The condition is usually detected during routine newborn screening, mandatory at hospitals in the U.S. As a result, Lucas has an intellectual disability.

Lucas and Madeline Howard though 18 months apart, were in many ways raised as twins according to mom, Lisa Howard. Photo credit: Lisa Howard

A second, arguably more challenging piece of Lucas’ story is the impact those first months had his emotional and mental health. Alongside the developmental disability that resulted from hypothyroidism, because of the neglect he experienced in the orphanage, Lucas developed many of the symptoms of Reactive Attachment Disorder (RAD), a condition that may develop if a child lacks comfort, nurturing and affection or fails to establish safe and secure attachments with others.

Todd Adamowich, Clinical Social Worker and Therapist, ​has worked with families battling attachment disorder and notes that these issues are common, particularly when the adopted child has been raised without a consistent attachment figure. “This often occurs with international adoptions where children are raised in isolation, in an orphanage (which are often over capacity by our standards), or in a traumatic environment. Behaviors can span the spectrum of mental illness (anxiety, depression, emotional dysregulation, schizophrenia, psychosis), behavioral issues such as opposition, anti-social behaviors, defiance, impulsivity, and attention problems, and developmental issues such as autism, Asperger’s or other types of delays depending on the situation. It is not uncommon to see these children struggle with verbal and non-verbal learning disorders, central processing difficulty, and other related concerns.  Typically, adoptive parents undergo rigorous screening and programs aimed at teaching them about the potential difficulties, strategies for managing them, and supports to connect too. With international adoptions, most of my clients report very little support, very few opportunities to learn strategies resulting in their feeling isolated and unsure what to do when problems arise. There is often an expectation that the adoption will be “smooth”, the child will adapt easily and will integrate into the family and the culture well. When this fantasy turns into reality, many adoptive families have to grieve the loss of their expectations and find resources and supports for the challenges they face.”

Lisa says, “There was a mindset back then that love would conquer everything. We were just starting to hear about attachment issues with these kids but there was this sense that we were ‘rescuing’ them and by taking them into our homes and our hearts we could ‘fix’ what was broken in them. That’s just not true.”

According to Adoptive Families, true RAD is rare, but attachment issues are not. Because infants experience and perceive emotions before they can fully process or understand them, a lack of nurturing and safe relationships in those first weeks and months of development can re-wire the brain. Experiences are filtered through a lens of safety and self-preservation making it very difficult for the child to develop trust-based relationships.


What is important to remember is that while there may be a higher percentage of RAD seen in children adopted internationally, any child can exhibit some of the symptoms of attachment disorder during their childhood. Just because the child spent time in an orphanage doesn’t mean they were neglected any more than having been raised in a biological family ensures a healthy nurturing environment. There are good orphanages with loving caregivers all over the world.

As with any mental or physical health challenge, the key is early intervention. From the day Lucas came home, the Howard’s have done everything in their power to see his physical and emotional needs are met. He takes regular medications for his physical and behavioral challenges and has seen counselors and therapists to help him navigate the already challenging world of adolescence.

Adamowich encourages parents to do their homework. “​Adoption can be a wonderful gift for all involved. It is important to speak to other adoptive families, to hear their experiences, their concerns, how they’ve managed. Finding support groups as an ongoing resource is important. Connecting with a family therapist or a social worker who specializes in issues regarding adoption is a good idea to help not only navigate the system, but to help predict challenges and to brainstorm solutions to those challenges.​ If looking to the international community for potential adoptable children, it is vital to learn about the culture that child is coming from, know something about how the child has been cared for during infancy and toddlerhood, and if possible, the history of the birth family. This is often impossible with international adoptions, but any information can be helpful.”

Lucas is never happier than when he gets to explore nature, whether it’s fishing with his dad or searching for critters in the creek behind his house. Photo credit: Lisa Howard.

Though he has struggled academically, Lisa says she’s made sure she found subtle ways to help Lucas fit in. “I’ve always said that while he is mentally challenged, he should always look like the coolest kid in the class. So if Nike’s were in or Adidas, or whatever the clothes were, he had them. It’s a little thing but actually it’s a really a big thing because it helps him feel – and look – like his peers. He’s benefitted from that.”

Just as with biological children or domestic adoptions, international adoptions are a mixed bag of success stories and less successful stories. As with any child, physical, mental and emotional health challenges are always a possibility and developing strong, healthy relationships take time and effort. Bonding with a child and offering them the hope and the promise of a forever home is a rare and precious gift, one many of us take for granted.

One final note, if you ask the parents of adopted children they’ll tell you their child isn’t the “lucky one” because they’ve been adopted. Most adoptive parents feel they are the ones who have been blessed, not their children, many of whom have survived trauma. They don’t want to be considered “saints” for adopting nor do they see themselves as better than biological parents, that’s just their journey.

Screen Shot 2017-05-19 at 9.48.57 PM
Paul, Madeline, Lucas & Lisa at Disney World, May, 2012. Photo Credit: Lisa Howard



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