I have written a new book,
Dyadic Developmental Psychotherapy: Essential Practices & Methods
which is due out later this year. It is as close to a treatment manual as one can get with an experimentally based approach for this evidence-based, effective, and empirically validated treatment.
The book describes the theory base of Dyadic Developmental Psychotherapy and the evidence base of the approach. Another chapter describes fourteen components of Dyadic Developmental Psychotherapy. A major chapter in the book describes the phases of treatment:
Developing the Alliance
Maintaining the Alliance
Exploration
Integration
Healing
and the differential uses of the components of Dyadic Developmental Psychotherapy in these phases.
There are chapters about working with care-givers and the importance of caregivers as the key-stone for successful treatment
The book has extensive transcripts and excerpts from actual treatment sessions to illustrate the components and phases and principles being described.
Therapists, parents, psychologists, researchers, professors, social workers, residential treatment staff, and child welfare staff will all find this book a valuable resource.
Sep 18, 2010
Sep 4, 2010
Dyadic Developmental Psychotherapy WIKI
There is a new Wiki devoted to Dyadic Developmental Psychotherapy that readers may want to view.
Click on this link to get there.
The url is: http://dyadicdevelopmentalpsychotherapy.wikia.com/wiki/Dyadic_Developmental_Psychotherapy_Wiki
The Wiki has just started, but already has many articles about Dyadic Developmental Psychotherapy and related topics that readers will find quite useful and interesting.
Click on this link to get there.
The url is: http://dyadicdevelopmentalpsychotherapy.wikia.com/wiki/Dyadic_Developmental_Psychotherapy_Wiki
The Wiki has just started, but already has many articles about Dyadic Developmental Psychotherapy and related topics that readers will find quite useful and interesting.
Aug 15, 2010
Fathers matter!
Most psychological research into parenting concentrates on the role of mothers but having a good relationship with one's father can also help people to cope better in later life. Researchers from California State University, Fullerton studied 912 people between the ages of 25 and 74. Over eight days they interviewed the participants about that day's experiences asking them about their mental state and any stressful events. The participants were also asked about the quality of their childhood relationships with their parents. The study found that more people were likely to say their childhood relationship was better with their mother than with their father; a difference that was more pronounced among men. People who had had a good relationship with their mother reported 3% less psychological distress compared to those who reported a poor relationship. Men who had had a good relationship with their father also reported less psychological distress but this effect was not as strong among women.
Researchers spoke to more than 900 men and women aged from 25 to 74 before reaching their conclusion.
Psychology Professor Melanie Mallers, of California State University-Fullerton, who led the research team, said: "Most studies on parenting focus on the relationship with the mother.
"But, as our study shows, fathers do play a unique and important role in the mental health of their children much later in life."
As part of the study, 912 adult men and women completed short daily telephone interviews about that day's experiences over an eight-day period.
The interviews focused on the participants' psychological and emotional distress - such as whether they were depressed, nervous, or sad - and if they had experienced any stressful events that day. These events were described as arguments, disagreements, work-related and family-related tensions and discrimination.
The participants also reported on the quality of their childhood relationships with their mother and father. For example, they answered questions such as: "How would you rate your relationship with your mother during the years when you were growing up?" and "How much time and attention did your mother give you when you needed it?"
The same questions were asked about fathers. The research took into account age, childhood and current family income, neuroticism and whether or not their parents were still alive.
Prof Mallers and her team found participants were more likely to say their childhood relationship with their mother was better than with their father, with more men reporting a better mother-child relationship than women.
People who reported they had a good mother-child relationship reported three per cent less psychological distress compared to those who reported a poor relationship.
Prof Mallers said: "I don't think these results are surprising, given that past research has shown mothers are often the primary care-giver and often the primary source of comfort.
"It got interesting when we examined the participants' relationship with their fathers and their daily emotional reaction to stress."
They also found that men who reported having a good relationship with their father during childhood were more likely to be less emotional when reacting to stressful events in their current daily lives than those who had a poor relationship. This was not found to be as common for the women in the study.
And Prof Mallers said the quality of mother and father relationships was significantly associated with how many stressful events the participants confronted on a daily basis. In other words, if they had a poor childhood relationship with both parents, they reported more stressful incidents over the eight-day study when compared to those who had a good relationship with their parents.
Prof Mallers said: "Perhaps having attentive and caring parents equips children with the experiences and skills necessary to more successfully navigate their relationships with other people throughout childhood and into adulthood."
She said it was difficult to come up with a concrete theory as to why men's relationship with their father had such an influence on their emotional reaction to stress, especially since this study included adults of all ages who were raised during very different eras in the United States.
Prof Mallers added: "The role of fathers has changed dramatically from the time the oldest participants were children.
"We do know that fathers have a unique style of interacting with their children, especially their sons.
"We need more research to help us uncover further influences of both mothers and fathers on the enduring emotional experiences of their children."
Prof Mallers presented the findings at the 118th Annual Convention of the American Psychological Association in San Diego.
Researchers spoke to more than 900 men and women aged from 25 to 74 before reaching their conclusion.
Psychology Professor Melanie Mallers, of California State University-Fullerton, who led the research team, said: "Most studies on parenting focus on the relationship with the mother.
"But, as our study shows, fathers do play a unique and important role in the mental health of their children much later in life."
As part of the study, 912 adult men and women completed short daily telephone interviews about that day's experiences over an eight-day period.
The interviews focused on the participants' psychological and emotional distress - such as whether they were depressed, nervous, or sad - and if they had experienced any stressful events that day. These events were described as arguments, disagreements, work-related and family-related tensions and discrimination.
The participants also reported on the quality of their childhood relationships with their mother and father. For example, they answered questions such as: "How would you rate your relationship with your mother during the years when you were growing up?" and "How much time and attention did your mother give you when you needed it?"
The same questions were asked about fathers. The research took into account age, childhood and current family income, neuroticism and whether or not their parents were still alive.
Prof Mallers and her team found participants were more likely to say their childhood relationship with their mother was better than with their father, with more men reporting a better mother-child relationship than women.
People who reported they had a good mother-child relationship reported three per cent less psychological distress compared to those who reported a poor relationship.
Prof Mallers said: "I don't think these results are surprising, given that past research has shown mothers are often the primary care-giver and often the primary source of comfort.
"It got interesting when we examined the participants' relationship with their fathers and their daily emotional reaction to stress."
They also found that men who reported having a good relationship with their father during childhood were more likely to be less emotional when reacting to stressful events in their current daily lives than those who had a poor relationship. This was not found to be as common for the women in the study.
And Prof Mallers said the quality of mother and father relationships was significantly associated with how many stressful events the participants confronted on a daily basis. In other words, if they had a poor childhood relationship with both parents, they reported more stressful incidents over the eight-day study when compared to those who had a good relationship with their parents.
Prof Mallers said: "Perhaps having attentive and caring parents equips children with the experiences and skills necessary to more successfully navigate their relationships with other people throughout childhood and into adulthood."
She said it was difficult to come up with a concrete theory as to why men's relationship with their father had such an influence on their emotional reaction to stress, especially since this study included adults of all ages who were raised during very different eras in the United States.
Prof Mallers added: "The role of fathers has changed dramatically from the time the oldest participants were children.
"We do know that fathers have a unique style of interacting with their children, especially their sons.
"We need more research to help us uncover further influences of both mothers and fathers on the enduring emotional experiences of their children."
Prof Mallers presented the findings at the 118th Annual Convention of the American Psychological Association in San Diego.
Jul 5, 2010
Update on Artym
(July 2) -- Torry-Ann Hansen, the Tennessee nurse who adopted 7-year-old Artyom Savelyev and then returned him because she said he wanted to kill her, apparently never bonded with the Russian boy. But she did give him a new name (Justin), a new language (English) and comfort food (burgers and fries, with ketchup).
For now, Artyom, once again under the care of the Russian state, is not being fed hamburgers, said Pavel Astakhov, the point man on all things Artyom -- though there is talk of ordering out for the boy's second-favorite dish, pizza. The Russians have also junked the American name ("He's Artyom in Russian Federation," one official said), but they're making sure he doesn't lose his English. "It's very important for his future," Astakhov explained.
In an image taken from Rossia 1 television channel, 7-year-old adopted Russian boy Artyom Savelyev gets into a minivan outside a police department office in Moscow, April 8.
Rossia 1 Television Channel / AP
In an image taken from Russian television, 7-year-old Artyom Savelyev gets into a minivan outside a police department in Moscow on April 8. Torry-Ann Hansen, the Tennessee woman who adopted Artyom, created a firestorm when she sent him back to his home country of Russia.
It is not exactly true that Artyom Savelyev has been transformed into the Russian Elian Gonzalez. While many Russians pity Artyom, no one is throwing any parades for him. Still, the analogy is not totally off base.
Less than a year ago, Artyom was living in an orphanage in the town of Partizansk, nine time zones east of Moscow and a few stops from the end of the Trans-Siberian Railway. He had been consigned to a remote corner of a vast country that doesn't think much of orphans -- had he never left the Russian Far East, odds are that Artyom would have faced prison, homelessness, venereal disease and/or premature death. And then, he was magically airlifted to America.
But for Hansen, it turned out that parenting a boy who may have been a victim of fetal alcohol syndrome and definitely had been subjected to violence and hunger was, well, trying. So on April 7, seven months after he arrived in his new hometown of Shelbyville, Tenn., Artyom's new grandmother took him to Dulles International Airport outside Washington. There, Nancy Hansen turned him over to the custody of United Airlines, and he was put on Flight 964 to Moscow's Domodedovo Airport. The flight would be just shy of 10 hours.
Landing in Moscow, he was met by Artur Lukyanov, who had been paid $200 by Nancy Hansen to take him to the Ministry of Education and Science, which has jurisdiction over adoptions. At the ministry, in Moscow's center, Lukyanov gave officials a letter from Torry-Ann Hansen claiming that Artyom had "severe psychopathic issues" and wanted to burn her house down.
Artyom's story soon became a Russian story -- about suffering, fortitude and a child's innocence. Because Artyom was no longer just Artyom but a metaphor for something much bigger, his story had to end triumphantly. America, in the guise of Torry-Ann Hansen, had rejected Russia, and then Russia, in the guise of Artyom, was saved by the Russian state.
And so it was that on April 8, when the twice-abandoned Elian Gonzalez of Siberia -- having zigzagged from post-Soviet backwater to Dixieland nightmare to the loving embrace of the Kremlin -- stepped off an airplane outside Moscow, his journey, Russia's journey, finally began to look up. That was the day everything turned around.
Into the Arms of the State
Artyom's story, naturally, requires an expert storyteller. That Pavel Astakhov has been assigned to that role suggests the Kremlin knows as much.
Astakhov, the 43-year-old, permanently tanned, coiffed and manicured superlawyer whom President Dmitry Medvedev late last year named children's rights commissioner, is the Judge Judy of Russia. Besides running a bustling practice -- according to his website, former clients include Moscow Mayor Yury Luzhkov and accused American spy Edmond Pope -- Astakhov hosts the television program "Chas Suda," or "Hour of the Court."
Russian Presidential Commissioner for Children's Rights, Pavel Astakhov, shows a copy of Artyom Savelyev's US passport to journalists near a children's hospital in Moscow on April 16.
EPA / ZUMA Press
Pavel Astakhov, the Russian presidential commissioner for children's rights, shows a copy of Artyom Savelyev's U.S. passport to journalists near a children's hospital in Moscow on April 16.
The program, which airs daily on state-run Ren TV, amounts to a propaganda organ meant to convince Russians that the Russian Federation is ruled by laws, not men (which is not true). In Judge Astakhov's courtroom, justice is all that counts, not bribes or boyars or even Vladimir Putin. As Astakhov's site notes, "Chas Suda" "creates respect for the law" and "contributes to a positive image of the court in the minds of the people."
Like celebrities everywhere, but especially in Russia, it is important to Astakhov that other people know he is always busy. The first time I called him, on his cell, he didn't answer; nor did he pick up the second, third or fourth time. Eventually, I sent him a text message, and a minute later Astakhov wrote back, saying I should call his assistant. After several scheduled phone interviews that never materialized, I caught the judge in his car going somewhere that, he said, was very important.
On the phone, he was guarded -- not the way lawyers can be guarded, choosing their words carefully to avoid being accused of something they didn't mean; rather, the way celebrities are guarded, shielding from public view the gilded utopia they inhabit.
Artyom, Astakhov said, had been removed to an "undisclosed location" -- an orphanage -- in central Moscow. "It's a special house for orphans," he said. "There are many specialists around him -- pedagogues, psychologists, teachers -- and only five children in this house right now. He is living in one room with a boy of his age." He said Artyom had been put on a special diet for children in his age group (he wouldn't specify what this consisted of) and that doctors had run a battery of tests on him.
Implying not so subtly that Torry-Ann Hansen must be crazy or blind, he added, "He is absolutely normal. I spoke with Artyom many, many times. I saw all the medical exams about his conditions, I mean, mentally and physically, and Artyom is very well."
Lukyanov, the driver, agreed with Astakhov. He said Artyom seemed like a regular little boy when he stepped off the plane. He was wearing a yellow jacket and had a Spider-Man backpack with a Spider-Man doll, a miniature car and pencils inside. But he was confused about where -- and who -- he was. While they were in Lukyanov's Ford heading into Moscow, Artyom began to cry and ask for his "Grandma Nancy." "The boy could not calm down for a few minutes," Lukyanov wrote on his website.
(Lukyanov posted a lengthy dispatch on the site after being accused, in Russia, of abandoning Artyom at the ministry. He insists he stayed with Artyom all day, until he deposited him at Hospital 21, a state children's hospital on the northeastern fringe of the city.)
"When I met him, I didn't know that he is Russian," Lukyanov told me. "After, in the office of the ministry, we recognized that within six months [in the United States] he had forgot his native language ... or pretended that he forgot. At the end of the day, he remembered Russian words and began to understand us better and better."
Astakhov said Artyom was not ready to meet journalists. Nor would he reveal any details about the orphanage where he's staying except to say it has had remarkable success placing orphans with foster and adoptive families. (In the past year, Astakhov said, the orphanage has placed 150 children. He did not say if these children had been placed with foreigners or Russians, who are generally resistant to taking in parentless children.)
That said, photographs of a smiling Artyom at the orphanage have popped up on the website of the state news agency RIA Novosti. In one picture, Artyom, in a short-sleeve, blue-and-white striped shirt, plays with the iconic wooden toy known as a matryoshka doll. Behind the little boy, with his tousled blond hair and toothy grin, is a bright orange stuffed bear and a freshly made twin-sized bed.
"The most traumatic months were in Torry's family, when she pulled his hair and she punished him for everything," Astakhov said. " 'Don't cry, don't yell, don't play, don't go out from this house.' Everything was prohibited for Artyom. I think it's over, and now we are doing all the best for Artyom's future, for Artyom's present."
America and the Scandale d'Artyom
One reason English could be important for Artyom's future is that he may opt to go back to America. That would be easy enough since he is now a dual citizen of Russia and the United States, which granted him citizenship when Hansen adopted him. As one former diplomat put it, "Your mother may give you back, but your motherland never will."
Astakhov said Julie Stufft, a U.S. Embassy official, had visited with Artyom at the orphanage. Stufft referred questions about the boy to embassy spokesman Kevin Kabumoto, who refused to discuss the case, citing the Privacy Act. Tom Armbruster, the U.S. consul general in Vladivostok, cited a May 13 statement issued by the State Department on U.S.-Russian talks on adoption and, presumably, how to make sure that people like Torry-Ann Hansen (or, worse yet, Peggy Sue Hilt, who in 2006 pleaded guilty to killing the Russian girl she'd adopted) don't wind up with future Artyoms.
Artyom Savelyev plays in a children's hospital in Moscow, Russia on April 9.
EPA / ZUMA Press
Artyom Savelyev is all smiles as he plays in a children's hospital in Moscow on April 9.
"Both teams are committed to reach an agreement to increase safeguards for intercountry adoption," Mary Ellen Hickey, head of the U.S. delegation, said in the statement. Furthermore, whatever agreements are hammered out will be "legally binding" and "each country will define its competent bodies responsible for coordinating bilateral cooperation in adoption."
That is exactly what the United States has resisted and Russia has sought for years. What brought an end to the impasse was the scandale d'Artyom. The Americans were embarrassed. The Russians were livid. Finally, the political alignment had shifted, and the Americans -- who have sought to make nice with the Russians ever since Barack Obama reset relations with the Kremlin -- signed off on a slew of new regulations and identity checks.
The final agreement, details of which have yet to be made public, is expected to be signed in a few months. This makes Russia happy (victory over America!) and comes at a low cost to the Obama administration: Many, if not most, of the people who adopt Russian children are churchgoing -- many got the idea to adopt a Russian child while doing missionary work in the former Soviet Union -- and white. (Adoption officials say Russia is a popular destination for adoptive U.S. parents because it has a huge cache of parentless kids with the "correct" skin color, unlike, say, China.) This is a constituency that did not vote for Obama in 2008 and is unlikely to do so in 2012.
Too Many Children, Not Enough Homes
Since the 1991 Soviet collapse, American families have adopted more than 50,000 Russian children. The pace of adoptions held steady in the 1990s but began to drop in 2003. Although no one at the Kremlin ever articulated a change in policy -- the Kremlin rarely, if ever, articulates changes in policy -- that decline parallels a shift in attitudes at the very top toward foreigners and especially Americans.
Now, a mere 1,700 to 1,800 Russian children are adopted by Americans yearly, despite ongoing demand. "It's all about saving the children," said Michelle Helton Jayroe, who traveled in December 2008 from her Alabama home to Samara, about 550 miles southeast of Moscow, with a friend who was adopting a little boy. "She would adopt 25 if her husband would allow. ... She's hoping for two more, at least."
That is likely to get tougher. Russia has permitted foreigners to adopt its children because there are not enough Russians to take them in. That's because most Russians are poor: In 2008, Russia ranked No. 75 in per capita income, with the average Russian grossing the equivalent of $9,660, between No. 74 Mexico and No. 76 Chile, according to a World Bank report this year.
And it's because, since Soviet times, there has been a stigma attached to orphans. "For many years, if a Russian family decided to adopt a child, they would fake a pregnancy," said Ekaterina Bridge, head of the Russian branch of the World Association for Children and Parents, the Renton, Wash., agency that facilitated Artyom's adoption. "They didn't want that someone would later tell their child. They'd prefer not to tell the child that he had been adopted."
Moscow has never been happy about the need for foreigners to pick up the slack. Like capitalism and world peace, the Russian leadership tends to view adoption as an instrument that may or may not serve its interests; the fact that these interests often diverge from those of Russia's roughly 700,000 orphans, most of whom remain in orphanages, is irrelevant.
This is especially troubling to parentless teenagers on the verge of "graduation." Every year about 20,000 kids, having recently turned 17, leave Russian orphanages, according to Anna Sergeeva, director of the New York office of the Russian Children's Welfare Society. "A majority of them fall into a high-risk category (crime, homelessness, prostitution)," she wrote in an e-mail. "Ten percent commit suicide, and only 4 percent are admitted to colleges or universities."
These figures would seem to suggest that Russia should push for more, not fewer, adoptions. Not so: Sergeeva predicted the number of adoptions would drop again this year.
A Country's Outrage -- and Ambivalence
Artyom's story, like that of the Iraq War and the Bush administration's handling of Hurricane Katrina, has provided the Russian state with a prophylactic that safeguards it against external criticism -- We're all rotten, aren't we? But more important, it reaffirms Russia's idea of Russia, that of a battered and impoverished people that fights and perseveres and defies the many forces arrayed against it: fascists, imperialists, CIA agents and, of course, soulless would-be mothers from Tennessee.
Alexandra Ochirova, an adoption specialist who sits on the 126-member Public Chamber, a government panel that is meant to serve as the nation's public conscience, was reflecting on the nature of motherhood. We were at the Winter Garden Cafe, at the National Hotel, across the street from Red Square, and Ochirova was sipping an espresso. She said she was deeply troubled -- pained -- by the case of Artyom Savelyev. "The only motivation to adopt a child is love," Ochirova declared. "This is all that must be there."
(Pavel Astakhov agreed when we spoke. "You really need only love and attention and, of course, patience. For example, Torry Hansen didn't have patience, love or attention.")
What about medical records? I asked Ochirova. Hansen had claimed that orphanage officials in Partizansk withheld information about Artyom that would have alerted her to his behavioral problems. "What information?" Ochirova said. "Was he a terrorist? A killer? Perhaps she was unaware that he didn't enjoy a king's upbringing."
When she was at Moscow State University, Ochirova studied philosophy (Immanuel Kant, Georg Hegel and, of course, Karl Marx) and the greatest of all Russian prophets, Fyodor Dostoevsky. The world would be a better place, she said, if its leaders, beginning with Barack Obama, read more Russian literature and especially more Dostoevsky, whose most famous novel, "The Brothers Karamazov," ends with a little boy's funeral.
She asked if Obama had been following the story of Artyom. I said that I had no idea but that he probably had other things to worry about: the oil spill, the economy, the war in Afghanistan. Ochirova became livid. "What can possibly be more serious than this problem? This is the first problem. What we really need is a new moral order."
No doubt. There's something strange about a country that is teeming with unwanted children and has no one to take them in and can't decide if it should let other people, in other countries, fill that niche. That ambivalence inhibits action, which spawns backlog and, ultimately, a permanent subset of parentless children.
Exhibit A: Artyom Savelyev, Russia's most famous parentless child. Adoption officials, Astakhov said, are reviewing the applications of three families hoping to adopt Artyom. Astakhov stressed that all of the families are Russian, but then he said that that is not important. "A little boy, a little girl, are very flexible. It does not matter to them."
In two to three months, Artyom will be placed in a new home, and then his life will begin. Astakhov wouldn't say much about the candidate families -- for instance, where they were before Torry-Ann Hansen showed up -- except that they live in Moscow and that they are all "promising."
"One of these families," Astakhov said, "is the family of former diplomats who have good experience with adopted children because they raised a boy who was adopted many years before. This family will be the best family for Artyom. Both mother and father speak English very well."
Peter Savodnik is a writer based in New York. His book about Lee Harvey Oswald's time in the Soviet Union, provisionally titled "The Interloper," will be published by Basic Books next year.
For now, Artyom, once again under the care of the Russian state, is not being fed hamburgers, said Pavel Astakhov, the point man on all things Artyom -- though there is talk of ordering out for the boy's second-favorite dish, pizza. The Russians have also junked the American name ("He's Artyom in Russian Federation," one official said), but they're making sure he doesn't lose his English. "It's very important for his future," Astakhov explained.
In an image taken from Rossia 1 television channel, 7-year-old adopted Russian boy Artyom Savelyev gets into a minivan outside a police department office in Moscow, April 8.
Rossia 1 Television Channel / AP
In an image taken from Russian television, 7-year-old Artyom Savelyev gets into a minivan outside a police department in Moscow on April 8. Torry-Ann Hansen, the Tennessee woman who adopted Artyom, created a firestorm when she sent him back to his home country of Russia.
It is not exactly true that Artyom Savelyev has been transformed into the Russian Elian Gonzalez. While many Russians pity Artyom, no one is throwing any parades for him. Still, the analogy is not totally off base.
Less than a year ago, Artyom was living in an orphanage in the town of Partizansk, nine time zones east of Moscow and a few stops from the end of the Trans-Siberian Railway. He had been consigned to a remote corner of a vast country that doesn't think much of orphans -- had he never left the Russian Far East, odds are that Artyom would have faced prison, homelessness, venereal disease and/or premature death. And then, he was magically airlifted to America.
But for Hansen, it turned out that parenting a boy who may have been a victim of fetal alcohol syndrome and definitely had been subjected to violence and hunger was, well, trying. So on April 7, seven months after he arrived in his new hometown of Shelbyville, Tenn., Artyom's new grandmother took him to Dulles International Airport outside Washington. There, Nancy Hansen turned him over to the custody of United Airlines, and he was put on Flight 964 to Moscow's Domodedovo Airport. The flight would be just shy of 10 hours.
Landing in Moscow, he was met by Artur Lukyanov, who had been paid $200 by Nancy Hansen to take him to the Ministry of Education and Science, which has jurisdiction over adoptions. At the ministry, in Moscow's center, Lukyanov gave officials a letter from Torry-Ann Hansen claiming that Artyom had "severe psychopathic issues" and wanted to burn her house down.
Artyom's story soon became a Russian story -- about suffering, fortitude and a child's innocence. Because Artyom was no longer just Artyom but a metaphor for something much bigger, his story had to end triumphantly. America, in the guise of Torry-Ann Hansen, had rejected Russia, and then Russia, in the guise of Artyom, was saved by the Russian state.
And so it was that on April 8, when the twice-abandoned Elian Gonzalez of Siberia -- having zigzagged from post-Soviet backwater to Dixieland nightmare to the loving embrace of the Kremlin -- stepped off an airplane outside Moscow, his journey, Russia's journey, finally began to look up. That was the day everything turned around.
Into the Arms of the State
Artyom's story, naturally, requires an expert storyteller. That Pavel Astakhov has been assigned to that role suggests the Kremlin knows as much.
Astakhov, the 43-year-old, permanently tanned, coiffed and manicured superlawyer whom President Dmitry Medvedev late last year named children's rights commissioner, is the Judge Judy of Russia. Besides running a bustling practice -- according to his website, former clients include Moscow Mayor Yury Luzhkov and accused American spy Edmond Pope -- Astakhov hosts the television program "Chas Suda," or "Hour of the Court."
Russian Presidential Commissioner for Children's Rights, Pavel Astakhov, shows a copy of Artyom Savelyev's US passport to journalists near a children's hospital in Moscow on April 16.
EPA / ZUMA Press
Pavel Astakhov, the Russian presidential commissioner for children's rights, shows a copy of Artyom Savelyev's U.S. passport to journalists near a children's hospital in Moscow on April 16.
The program, which airs daily on state-run Ren TV, amounts to a propaganda organ meant to convince Russians that the Russian Federation is ruled by laws, not men (which is not true). In Judge Astakhov's courtroom, justice is all that counts, not bribes or boyars or even Vladimir Putin. As Astakhov's site notes, "Chas Suda" "creates respect for the law" and "contributes to a positive image of the court in the minds of the people."
Like celebrities everywhere, but especially in Russia, it is important to Astakhov that other people know he is always busy. The first time I called him, on his cell, he didn't answer; nor did he pick up the second, third or fourth time. Eventually, I sent him a text message, and a minute later Astakhov wrote back, saying I should call his assistant. After several scheduled phone interviews that never materialized, I caught the judge in his car going somewhere that, he said, was very important.
On the phone, he was guarded -- not the way lawyers can be guarded, choosing their words carefully to avoid being accused of something they didn't mean; rather, the way celebrities are guarded, shielding from public view the gilded utopia they inhabit.
Artyom, Astakhov said, had been removed to an "undisclosed location" -- an orphanage -- in central Moscow. "It's a special house for orphans," he said. "There are many specialists around him -- pedagogues, psychologists, teachers -- and only five children in this house right now. He is living in one room with a boy of his age." He said Artyom had been put on a special diet for children in his age group (he wouldn't specify what this consisted of) and that doctors had run a battery of tests on him.
Implying not so subtly that Torry-Ann Hansen must be crazy or blind, he added, "He is absolutely normal. I spoke with Artyom many, many times. I saw all the medical exams about his conditions, I mean, mentally and physically, and Artyom is very well."
Lukyanov, the driver, agreed with Astakhov. He said Artyom seemed like a regular little boy when he stepped off the plane. He was wearing a yellow jacket and had a Spider-Man backpack with a Spider-Man doll, a miniature car and pencils inside. But he was confused about where -- and who -- he was. While they were in Lukyanov's Ford heading into Moscow, Artyom began to cry and ask for his "Grandma Nancy." "The boy could not calm down for a few minutes," Lukyanov wrote on his website.
(Lukyanov posted a lengthy dispatch on the site after being accused, in Russia, of abandoning Artyom at the ministry. He insists he stayed with Artyom all day, until he deposited him at Hospital 21, a state children's hospital on the northeastern fringe of the city.)
"When I met him, I didn't know that he is Russian," Lukyanov told me. "After, in the office of the ministry, we recognized that within six months [in the United States] he had forgot his native language ... or pretended that he forgot. At the end of the day, he remembered Russian words and began to understand us better and better."
Astakhov said Artyom was not ready to meet journalists. Nor would he reveal any details about the orphanage where he's staying except to say it has had remarkable success placing orphans with foster and adoptive families. (In the past year, Astakhov said, the orphanage has placed 150 children. He did not say if these children had been placed with foreigners or Russians, who are generally resistant to taking in parentless children.)
That said, photographs of a smiling Artyom at the orphanage have popped up on the website of the state news agency RIA Novosti. In one picture, Artyom, in a short-sleeve, blue-and-white striped shirt, plays with the iconic wooden toy known as a matryoshka doll. Behind the little boy, with his tousled blond hair and toothy grin, is a bright orange stuffed bear and a freshly made twin-sized bed.
"The most traumatic months were in Torry's family, when she pulled his hair and she punished him for everything," Astakhov said. " 'Don't cry, don't yell, don't play, don't go out from this house.' Everything was prohibited for Artyom. I think it's over, and now we are doing all the best for Artyom's future, for Artyom's present."
America and the Scandale d'Artyom
One reason English could be important for Artyom's future is that he may opt to go back to America. That would be easy enough since he is now a dual citizen of Russia and the United States, which granted him citizenship when Hansen adopted him. As one former diplomat put it, "Your mother may give you back, but your motherland never will."
Astakhov said Julie Stufft, a U.S. Embassy official, had visited with Artyom at the orphanage. Stufft referred questions about the boy to embassy spokesman Kevin Kabumoto, who refused to discuss the case, citing the Privacy Act. Tom Armbruster, the U.S. consul general in Vladivostok, cited a May 13 statement issued by the State Department on U.S.-Russian talks on adoption and, presumably, how to make sure that people like Torry-Ann Hansen (or, worse yet, Peggy Sue Hilt, who in 2006 pleaded guilty to killing the Russian girl she'd adopted) don't wind up with future Artyoms.
Artyom Savelyev plays in a children's hospital in Moscow, Russia on April 9.
EPA / ZUMA Press
Artyom Savelyev is all smiles as he plays in a children's hospital in Moscow on April 9.
"Both teams are committed to reach an agreement to increase safeguards for intercountry adoption," Mary Ellen Hickey, head of the U.S. delegation, said in the statement. Furthermore, whatever agreements are hammered out will be "legally binding" and "each country will define its competent bodies responsible for coordinating bilateral cooperation in adoption."
That is exactly what the United States has resisted and Russia has sought for years. What brought an end to the impasse was the scandale d'Artyom. The Americans were embarrassed. The Russians were livid. Finally, the political alignment had shifted, and the Americans -- who have sought to make nice with the Russians ever since Barack Obama reset relations with the Kremlin -- signed off on a slew of new regulations and identity checks.
The final agreement, details of which have yet to be made public, is expected to be signed in a few months. This makes Russia happy (victory over America!) and comes at a low cost to the Obama administration: Many, if not most, of the people who adopt Russian children are churchgoing -- many got the idea to adopt a Russian child while doing missionary work in the former Soviet Union -- and white. (Adoption officials say Russia is a popular destination for adoptive U.S. parents because it has a huge cache of parentless kids with the "correct" skin color, unlike, say, China.) This is a constituency that did not vote for Obama in 2008 and is unlikely to do so in 2012.
Too Many Children, Not Enough Homes
Since the 1991 Soviet collapse, American families have adopted more than 50,000 Russian children. The pace of adoptions held steady in the 1990s but began to drop in 2003. Although no one at the Kremlin ever articulated a change in policy -- the Kremlin rarely, if ever, articulates changes in policy -- that decline parallels a shift in attitudes at the very top toward foreigners and especially Americans.
Now, a mere 1,700 to 1,800 Russian children are adopted by Americans yearly, despite ongoing demand. "It's all about saving the children," said Michelle Helton Jayroe, who traveled in December 2008 from her Alabama home to Samara, about 550 miles southeast of Moscow, with a friend who was adopting a little boy. "She would adopt 25 if her husband would allow. ... She's hoping for two more, at least."
That is likely to get tougher. Russia has permitted foreigners to adopt its children because there are not enough Russians to take them in. That's because most Russians are poor: In 2008, Russia ranked No. 75 in per capita income, with the average Russian grossing the equivalent of $9,660, between No. 74 Mexico and No. 76 Chile, according to a World Bank report this year.
And it's because, since Soviet times, there has been a stigma attached to orphans. "For many years, if a Russian family decided to adopt a child, they would fake a pregnancy," said Ekaterina Bridge, head of the Russian branch of the World Association for Children and Parents, the Renton, Wash., agency that facilitated Artyom's adoption. "They didn't want that someone would later tell their child. They'd prefer not to tell the child that he had been adopted."
Moscow has never been happy about the need for foreigners to pick up the slack. Like capitalism and world peace, the Russian leadership tends to view adoption as an instrument that may or may not serve its interests; the fact that these interests often diverge from those of Russia's roughly 700,000 orphans, most of whom remain in orphanages, is irrelevant.
This is especially troubling to parentless teenagers on the verge of "graduation." Every year about 20,000 kids, having recently turned 17, leave Russian orphanages, according to Anna Sergeeva, director of the New York office of the Russian Children's Welfare Society. "A majority of them fall into a high-risk category (crime, homelessness, prostitution)," she wrote in an e-mail. "Ten percent commit suicide, and only 4 percent are admitted to colleges or universities."
These figures would seem to suggest that Russia should push for more, not fewer, adoptions. Not so: Sergeeva predicted the number of adoptions would drop again this year.
A Country's Outrage -- and Ambivalence
Artyom's story, like that of the Iraq War and the Bush administration's handling of Hurricane Katrina, has provided the Russian state with a prophylactic that safeguards it against external criticism -- We're all rotten, aren't we? But more important, it reaffirms Russia's idea of Russia, that of a battered and impoverished people that fights and perseveres and defies the many forces arrayed against it: fascists, imperialists, CIA agents and, of course, soulless would-be mothers from Tennessee.
Alexandra Ochirova, an adoption specialist who sits on the 126-member Public Chamber, a government panel that is meant to serve as the nation's public conscience, was reflecting on the nature of motherhood. We were at the Winter Garden Cafe, at the National Hotel, across the street from Red Square, and Ochirova was sipping an espresso. She said she was deeply troubled -- pained -- by the case of Artyom Savelyev. "The only motivation to adopt a child is love," Ochirova declared. "This is all that must be there."
(Pavel Astakhov agreed when we spoke. "You really need only love and attention and, of course, patience. For example, Torry Hansen didn't have patience, love or attention.")
What about medical records? I asked Ochirova. Hansen had claimed that orphanage officials in Partizansk withheld information about Artyom that would have alerted her to his behavioral problems. "What information?" Ochirova said. "Was he a terrorist? A killer? Perhaps she was unaware that he didn't enjoy a king's upbringing."
When she was at Moscow State University, Ochirova studied philosophy (Immanuel Kant, Georg Hegel and, of course, Karl Marx) and the greatest of all Russian prophets, Fyodor Dostoevsky. The world would be a better place, she said, if its leaders, beginning with Barack Obama, read more Russian literature and especially more Dostoevsky, whose most famous novel, "The Brothers Karamazov," ends with a little boy's funeral.
She asked if Obama had been following the story of Artyom. I said that I had no idea but that he probably had other things to worry about: the oil spill, the economy, the war in Afghanistan. Ochirova became livid. "What can possibly be more serious than this problem? This is the first problem. What we really need is a new moral order."
No doubt. There's something strange about a country that is teeming with unwanted children and has no one to take them in and can't decide if it should let other people, in other countries, fill that niche. That ambivalence inhibits action, which spawns backlog and, ultimately, a permanent subset of parentless children.
Exhibit A: Artyom Savelyev, Russia's most famous parentless child. Adoption officials, Astakhov said, are reviewing the applications of three families hoping to adopt Artyom. Astakhov stressed that all of the families are Russian, but then he said that that is not important. "A little boy, a little girl, are very flexible. It does not matter to them."
In two to three months, Artyom will be placed in a new home, and then his life will begin. Astakhov wouldn't say much about the candidate families -- for instance, where they were before Torry-Ann Hansen showed up -- except that they live in Moscow and that they are all "promising."
"One of these families," Astakhov said, "is the family of former diplomats who have good experience with adopted children because they raised a boy who was adopted many years before. This family will be the best family for Artyom. Both mother and father speak English very well."
Peter Savodnik is a writer based in New York. His book about Lee Harvey Oswald's time in the Soviet Union, provisionally titled "The Interloper," will be published by Basic Books next year.
Suicide and Child Abuse: a link
Suicide is one of the leading causes of death worldwide but what causes it is still not well understood. Mental-health problems are an important risk factor but most people with a mental-health problem do not think about killing themselves. There is strong evidence that people's experiences contribute more towards their mental-health problems than their genes and that bad experiences in people's childhood are linked to more thoughts about, or attempts at, killing oneself in later life. However, there has been less research into this than into genetic factors or mental-health problems. A team of researchers led by Ronny Bruffaerts from Gasthuisberg University Hospital in Belgium studied an international sample of 55,299 people asking them about their experiences in childhood and whether they had thought about, or tried to kill themselves. They found that bad experiences in childhood were associated with an increased risk of suicide attempts and thoughts of suicide. Sexual and physical abuse, especially during adolescence, were consistently the strongest risk factors.
Reference:
Bruffaerts, Ronny ... [et al] - Childhood adversities as risk factors for onset and persistence of suicidal behaviour. British Journal of Psychiatry, July 2010, 197(1), 20-27
Seel
Reference:
Bruffaerts, Ronny ... [et al] - Childhood adversities as risk factors for onset and persistence of suicidal behaviour. British Journal of Psychiatry, July 2010, 197(1), 20-27
Seel
May 2, 2010
Adoption: What disclosures are requuired?
The lawsuit described in a recent New York Times article by Pam Belluck raised important questions regarding the disclosures that should be made by adoption agencies to their adoptive families.
At the Center for Family Development we frequently find that families have not been fully or adequately informed regarding the mental health, health, and psychological status of the child they are wanting to adopt. In many instances the agency has not informed the family of the potential risks and issues that may be presented. We find that this lack is more common in international adoptions, and particularly in those programs that bring a child to the US for a few weeks for "camp," with a family, and more often with adoptions from Russian and Eastern Europe. We do find that agencies doing domestic adoptions of children in the child welfare system seem to do a more comprehensive job of fully informing parents of actual and potential issues.
By Pam Belluck
New York Times
Apr 28, 2010
Scores of complaints have been made in recent years against adoption agencies by people claiming they were inadequately informed or ill-prepared for problems their children turned out to have.
Many state laws and the Hague Convention now require agencies to disclose “reasonably available” records. But it can be unclear, especially in international cases, how assertive they are expected to be in getting such information.
The case of Chip and Julie Harshaw of Virginia Beach is, in some ways, the reverse of the now-familiar story of a Tennessee mother who put her Russian-born child on a plane home: The Harshaws are committed to raising their Russian son, even though they say they would not have adopted him had they known how severely impaired he was. But when they decided to adopt, the Harshaws told their agency they could care only for a child with minimal health problems and “a good prognosis for normal development,” according to notes in the adoption agency’s paperwork.
They rejected one child because he had abuse-inflicted burns. But when a toddler in a Siberian orphanage appeared to fit their criteria, they brought the boy, Roman, home. ” ‘A beautiful, healthy, on-target, blond-haired boy’ was what they had quoted to us,” Julie Harshaw said.
After the adoption in 2004, Roman began showing “uncontrollable hyperactivity” and aggression, Julie Harshaw said. He has threatened their 5-year-old biological daughter with a steak knife and a two-by-four, and held her underwater in a pool. Their 13-year-old biological son has felt so much stress that he has required therapy.
Therapeutic programs have ejected Roman for kicking, biting, hitting and, most recently, on his 8th birthday, pulling out three of his teeth using a pen cap, fork or spoon.
Doctors finally diagnosed fetal alcohol spectrum disorder, brain damage and neuropsychiatric problems in Roman, whose IQ is 53. He was recently placed in an institution and is not expected to ever live independently, one of his doctors said.
The Harshaws are suing the agency, Bethany Christian Services, seeking compensation for the care Roman will need.
After Roman’s problems were diagnosed, the agency offered to end the adoption, to try placing Roman with another family. The Harshaws refused. “He’s not a dog; you don’t take him to a pound,” Julie Harshaw said.
The family claims that Bethany indicated, inaccurately, that a Russian doctor working for the agency had examined Roman, and that Bethany gave them incomplete medical information when more detailed records were available. (Such records were produced by Bethany more than two years later.)
Bethany, which calls itself “the nation’s largest adoption agency,” disputes most of the claims.
“Bethany is a highly respected adoption agency that provided all the appropriate information for consideration by the Harshaws,” said Mark Zausmer, a lawyer for Bethany, based in Michigan. “Bethany provided this family counseling, extensive documentation, opportunities to consult with physicians, medical records and other materials from which they could fully evaluate how to proceed.”
No organization tracks the number of cases against adoption agencies, and academics and industry officials say many are settled out of court and sealed, so the outcomes are unknown.
But these days, “a far greater percentage of these wrongful adoption suits relate to international adoptions,” said Marianne Blair, a University of Tulsa law professor.
Chuck Johnson, acting chief executive of the National Council for Adoption, an advocacy group, said, “There have been a growing number of families that have sued when they adopted a child from another country.”
Some lawsuits, Johnson said, come from families “expecting you to do the impossible when you did all you could,” but he said there had also been “agencies that have purposely concealed information.”
Issues of disclosure have drawn increasing attention in recent years. Lawsuits erupted in the 1980s over domestic adoptions in which histories of abuse and other problems were kept from adoptive parents.
“The philosophy was the blank slate, that adoption is a new start,” Blair said. Now, she said, experts believe that “disclosure of health information is vital.”
As a result, many states enacted disclosure laws, followed by similar requirements in the Hague Convention, which apply to countries that ratify the treaty, as the United States did in 2008. Russia has signed the agreement but has not yet ratified it.
Those regulations were developing as the Harshaws’ adoption was proceeding, and at most agencies, “the atmosphere was definitely an emphasis in getting what could be obtained and making sure that they disclose that,” said Joan H. Hollinger, a law professor at the University of California, Berkeley, who is serving as an expert witness for the Harshaws. Agencies were also focused on “preparation of adoptive families for what they might encounter,” Hollinger said.
Bethany says it clearly advised the family that children from Russia could have problems, including serious ones, and that records might be inaccurate.
While the Harshaws’ pediatrician raised overall risks after reviewing a video of Roman and a two-page medical summary, observing that some of the notations could indicate learning disabilities, she saw no specific indications of severe problems on the pre-adoption records provided. She noted a lack of detailed, up-to-date information and said she could not see Roman’s face clearly. (Facial characteristics may provide clues to health deficiencies.)
“They were warned about generalities,” said their lawyer, Samuel C. Totaro Jr., but the agency caseworker told them a Russian-trained doctor based in New York had “gone over there and seen him, and you have a healthy, on-target child, and the family took great reassurance from that.”
In a deposition, the caseworker acknowledged she had said that the doctor, Michael Dubrovsky, visited the orphanages to “see the children” and review pictures, videos and medical information. The agency says the Harshaws misinterpreted that to mean Dubrovsky had examined Roman.
In a deposition, Dubrovsky said he had never seen Roman, had not practiced medicine for years and was a facilitator for Bethany, not a medical screener.
The agency also suggests that the fetal alcohol syndrome was unlikely to have been detected before the adoption, noting that the Harshaws did not receive that diagnosis until two years later.
Zausmer said the agency did not conceal information and provided a translated synopsis of the Russian medical records that was standard at the time.
“We don’t believe that there was anything in the Russian records that would have materially affected any adoption decision,” Zausmer said.
But Dr. Ronald S. Federici, a neuropsychologist who diagnosed Roman’s illness, said the full 10-page medical record the agency produced after the adoption, at the parents’ urging, would have shown that “the boy had fetal alcohol syndrome.”
The Harshaws hope the institution can stabilize Roman enough to send him home; either way, he will need extensive lifetime care.
“What we’ve been through and what we’ve lost,” Chip Harshaw said. “Every day is ‘Groundhog Day,’ a repeat of the stress and anger and frustration.”
At the Center for Family Development we frequently find that families have not been fully or adequately informed regarding the mental health, health, and psychological status of the child they are wanting to adopt. In many instances the agency has not informed the family of the potential risks and issues that may be presented. We find that this lack is more common in international adoptions, and particularly in those programs that bring a child to the US for a few weeks for "camp," with a family, and more often with adoptions from Russian and Eastern Europe. We do find that agencies doing domestic adoptions of children in the child welfare system seem to do a more comprehensive job of fully informing parents of actual and potential issues.
By Pam Belluck
New York Times
Apr 28, 2010
Scores of complaints have been made in recent years against adoption agencies by people claiming they were inadequately informed or ill-prepared for problems their children turned out to have.
Many state laws and the Hague Convention now require agencies to disclose “reasonably available” records. But it can be unclear, especially in international cases, how assertive they are expected to be in getting such information.
The case of Chip and Julie Harshaw of Virginia Beach is, in some ways, the reverse of the now-familiar story of a Tennessee mother who put her Russian-born child on a plane home: The Harshaws are committed to raising their Russian son, even though they say they would not have adopted him had they known how severely impaired he was. But when they decided to adopt, the Harshaws told their agency they could care only for a child with minimal health problems and “a good prognosis for normal development,” according to notes in the adoption agency’s paperwork.
They rejected one child because he had abuse-inflicted burns. But when a toddler in a Siberian orphanage appeared to fit their criteria, they brought the boy, Roman, home. ” ‘A beautiful, healthy, on-target, blond-haired boy’ was what they had quoted to us,” Julie Harshaw said.
After the adoption in 2004, Roman began showing “uncontrollable hyperactivity” and aggression, Julie Harshaw said. He has threatened their 5-year-old biological daughter with a steak knife and a two-by-four, and held her underwater in a pool. Their 13-year-old biological son has felt so much stress that he has required therapy.
Therapeutic programs have ejected Roman for kicking, biting, hitting and, most recently, on his 8th birthday, pulling out three of his teeth using a pen cap, fork or spoon.
Doctors finally diagnosed fetal alcohol spectrum disorder, brain damage and neuropsychiatric problems in Roman, whose IQ is 53. He was recently placed in an institution and is not expected to ever live independently, one of his doctors said.
The Harshaws are suing the agency, Bethany Christian Services, seeking compensation for the care Roman will need.
After Roman’s problems were diagnosed, the agency offered to end the adoption, to try placing Roman with another family. The Harshaws refused. “He’s not a dog; you don’t take him to a pound,” Julie Harshaw said.
The family claims that Bethany indicated, inaccurately, that a Russian doctor working for the agency had examined Roman, and that Bethany gave them incomplete medical information when more detailed records were available. (Such records were produced by Bethany more than two years later.)
Bethany, which calls itself “the nation’s largest adoption agency,” disputes most of the claims.
“Bethany is a highly respected adoption agency that provided all the appropriate information for consideration by the Harshaws,” said Mark Zausmer, a lawyer for Bethany, based in Michigan. “Bethany provided this family counseling, extensive documentation, opportunities to consult with physicians, medical records and other materials from which they could fully evaluate how to proceed.”
No organization tracks the number of cases against adoption agencies, and academics and industry officials say many are settled out of court and sealed, so the outcomes are unknown.
But these days, “a far greater percentage of these wrongful adoption suits relate to international adoptions,” said Marianne Blair, a University of Tulsa law professor.
Chuck Johnson, acting chief executive of the National Council for Adoption, an advocacy group, said, “There have been a growing number of families that have sued when they adopted a child from another country.”
Some lawsuits, Johnson said, come from families “expecting you to do the impossible when you did all you could,” but he said there had also been “agencies that have purposely concealed information.”
Issues of disclosure have drawn increasing attention in recent years. Lawsuits erupted in the 1980s over domestic adoptions in which histories of abuse and other problems were kept from adoptive parents.
“The philosophy was the blank slate, that adoption is a new start,” Blair said. Now, she said, experts believe that “disclosure of health information is vital.”
As a result, many states enacted disclosure laws, followed by similar requirements in the Hague Convention, which apply to countries that ratify the treaty, as the United States did in 2008. Russia has signed the agreement but has not yet ratified it.
Those regulations were developing as the Harshaws’ adoption was proceeding, and at most agencies, “the atmosphere was definitely an emphasis in getting what could be obtained and making sure that they disclose that,” said Joan H. Hollinger, a law professor at the University of California, Berkeley, who is serving as an expert witness for the Harshaws. Agencies were also focused on “preparation of adoptive families for what they might encounter,” Hollinger said.
Bethany says it clearly advised the family that children from Russia could have problems, including serious ones, and that records might be inaccurate.
While the Harshaws’ pediatrician raised overall risks after reviewing a video of Roman and a two-page medical summary, observing that some of the notations could indicate learning disabilities, she saw no specific indications of severe problems on the pre-adoption records provided. She noted a lack of detailed, up-to-date information and said she could not see Roman’s face clearly. (Facial characteristics may provide clues to health deficiencies.)
“They were warned about generalities,” said their lawyer, Samuel C. Totaro Jr., but the agency caseworker told them a Russian-trained doctor based in New York had “gone over there and seen him, and you have a healthy, on-target child, and the family took great reassurance from that.”
In a deposition, the caseworker acknowledged she had said that the doctor, Michael Dubrovsky, visited the orphanages to “see the children” and review pictures, videos and medical information. The agency says the Harshaws misinterpreted that to mean Dubrovsky had examined Roman.
In a deposition, Dubrovsky said he had never seen Roman, had not practiced medicine for years and was a facilitator for Bethany, not a medical screener.
The agency also suggests that the fetal alcohol syndrome was unlikely to have been detected before the adoption, noting that the Harshaws did not receive that diagnosis until two years later.
Zausmer said the agency did not conceal information and provided a translated synopsis of the Russian medical records that was standard at the time.
“We don’t believe that there was anything in the Russian records that would have materially affected any adoption decision,” Zausmer said.
But Dr. Ronald S. Federici, a neuropsychologist who diagnosed Roman’s illness, said the full 10-page medical record the agency produced after the adoption, at the parents’ urging, would have shown that “the boy had fetal alcohol syndrome.”
The Harshaws hope the institution can stabilize Roman enough to send him home; either way, he will need extensive lifetime care.
“What we’ve been through and what we’ve lost,” Chip Harshaw said. “Every day is ‘Groundhog Day,’ a repeat of the stress and anger and frustration.”
Apr 28, 2010
Bipolar Disorder in Children: Is it being Over-diagnosed?
Is Bipolar Disorder being over-diagnosed in children?
Many people erroneously argue that it is, so let's take a look at the evidence. First, I am talking about children aged five years into adolescence who actually meet the full DSM-IV criteria for Bipolar Disorder. I am not discussing children who only have irritability or aggression without any other manic criteria.
FACTS:
In 1994/1995 the frequency of the Bipolar Diagnosis was 25 cases per 100,000. In 2002/03 the frequecny increaed over forty-fold to 1003 cases per 100,000. (See: National Trends in the Outpatient Diagnosis and Treatment of Bipolar Disorder in Youth, Carmen Moreno, MD; Gonzalo Laje, MD; Carlos Blanco, MD, PhD; Huiping Jiang, PhD; Andrew B. Schmidt, CSW; Mark Olfson, MD, MPH, Arch Gen Psychiatry. 2007;64(9):1032-1039.)
Put another way, the diagnosis of Bipolar Disorder rose from 0.01% in 1994 to 0.44% in 2002. That is certainly a 40X increase, but is it really over-diagnosis?
The standard method to estimate the actual prevalence of psychiatric conditions is to conduct an epidemiological study, where trained researchers study large representative samples of the general population (not preselected clinical samples) with standardized, validated instruments (like the SCID or MINI or CIDI) to assess and diagnose the general population using DSM-IV criteria (not just irritability or aggression in children as bipolar disorder, for instance). Using those methods in over 5000 persons, the most recent analysis (see: Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication
Ronald C. Kessler, PhD; Patricia Berglund, MBA; Olga Demler, MA, MS; Robert Jin, MA; Kathleen R. Merikangas, PhD; Ellen E. Walters, MS, Arch Gen Psychiatry. 2005;62:593-602.) reports a one year adult prevalence of bipolar disorder (types I and II) of 3.9%. In an analysis of age of onset in the same citation above, the study found that bipolar disorder began before adulthood in a substantial minority of persons: in 25% of persons, it began by age 17, in 10% it began by age 13.
Let's do the math now and see what results. Excluding the adolescents up to age 17, and using the lower range of the NCS data:
If 10% of bipolar disorder begins by age 13, and 3.9% of the total population is diagnosable with the condition using DSM-IV criteria in a community-based epidemiological study of actual prevalence, then how many children should that clinical study have diagnosed with bipolar disorder? 0.10 multiplied by 0.39 is 0.039, or 0.39%. If we round to 0.4%, then we have the actual prevalence of bipolar disorder in children. The vaunted 40-fold increase from near zero led to the diagnosis being made in 0.4% of children based on percentage of office visits.
0.39% is about the same as 0.44%, so the purported evidence for over-diagnosis seems underwhelming, to say the least.
Many people erroneously argue that it is, so let's take a look at the evidence. First, I am talking about children aged five years into adolescence who actually meet the full DSM-IV criteria for Bipolar Disorder. I am not discussing children who only have irritability or aggression without any other manic criteria.
FACTS:
In 1994/1995 the frequency of the Bipolar Diagnosis was 25 cases per 100,000. In 2002/03 the frequecny increaed over forty-fold to 1003 cases per 100,000. (See: National Trends in the Outpatient Diagnosis and Treatment of Bipolar Disorder in Youth, Carmen Moreno, MD; Gonzalo Laje, MD; Carlos Blanco, MD, PhD; Huiping Jiang, PhD; Andrew B. Schmidt, CSW; Mark Olfson, MD, MPH, Arch Gen Psychiatry. 2007;64(9):1032-1039.)
Put another way, the diagnosis of Bipolar Disorder rose from 0.01% in 1994 to 0.44% in 2002. That is certainly a 40X increase, but is it really over-diagnosis?
The standard method to estimate the actual prevalence of psychiatric conditions is to conduct an epidemiological study, where trained researchers study large representative samples of the general population (not preselected clinical samples) with standardized, validated instruments (like the SCID or MINI or CIDI) to assess and diagnose the general population using DSM-IV criteria (not just irritability or aggression in children as bipolar disorder, for instance). Using those methods in over 5000 persons, the most recent analysis (see: Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication
Ronald C. Kessler, PhD; Patricia Berglund, MBA; Olga Demler, MA, MS; Robert Jin, MA; Kathleen R. Merikangas, PhD; Ellen E. Walters, MS, Arch Gen Psychiatry. 2005;62:593-602.) reports a one year adult prevalence of bipolar disorder (types I and II) of 3.9%. In an analysis of age of onset in the same citation above, the study found that bipolar disorder began before adulthood in a substantial minority of persons: in 25% of persons, it began by age 17, in 10% it began by age 13.
Let's do the math now and see what results. Excluding the adolescents up to age 17, and using the lower range of the NCS data:
If 10% of bipolar disorder begins by age 13, and 3.9% of the total population is diagnosable with the condition using DSM-IV criteria in a community-based epidemiological study of actual prevalence, then how many children should that clinical study have diagnosed with bipolar disorder? 0.10 multiplied by 0.39 is 0.039, or 0.39%. If we round to 0.4%, then we have the actual prevalence of bipolar disorder in children. The vaunted 40-fold increase from near zero led to the diagnosis being made in 0.4% of children based on percentage of office visits.
0.39% is about the same as 0.44%, so the purported evidence for over-diagnosis seems underwhelming, to say the least.
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