Senate Testimony of Dr. Ronald Federici

STATEMENT OF RONALD S. FEDERICI, PSY.D., CLINICAL DIRECTOR,
PSYCHIATRIC AND NEUROPSYCHOLOGICAL ASSOCIATES, P.C.,
ALEXANDRIA, VIRGINIA

Dr. Federici. Mr. Chairman, Senator Landrieu, it is a
pleasure to be here. Committee members, thank you very much for
allowing me the opportunity to testify.
My name is Dr. Ronald Federici. I am a developmental
neuropsychologist, which basically means I specialize in
evaluating children with neurodevelopmental and psychiatric
difficulties. I am Professor of Pediatrics and Neuropsychology
and Child Development. I lecture extensively throughout the
United States and internationally. And I am also an honorary
member of the remaining Department of Child Welfare, because my
medical team works extensively in Romania, working on the
institution projects.
I am also very proud to be the adoptive parent of four
internationally adopted children, and have recently gained
guardianship with two other children in Romania.
My professional colleagues in international adoption
medicine have basically designated me as the one who has seen
the most difficult children. My estimate is that I have seen
over 1,500 to 1,600 internationally adopted children who are in
their school age years for various evaluations for neurological
or psychiatric difficulties.
Basically, I am speaking to the committee on behalf of my
work and research, which I am also going to offer to the
committee, as well as some other supportive documentation. And
I am very proud to have many of the families and support groups
here in the audience who I have worked alongside for many, many
years, who would corroborate some of the difficulties that have
surfaced regarding international adoptions and adoption
practices.
While I am not an attorney, my job is to be an investigator
and work with the families to help them provide the most
detailed assessment of their child's special needs, and also to
help develop the most appropriate treatment plans to bring the
child to their maximum potential.
If I may just say that I have probably, in my research
sample, and it is included in my testimony which the committee
has already, we are organizing a very detailed research sample,
in conjunction with Dr. Dana Johnson and the University of
Minnesota, and Dr. Pat Mason, of Emory University, which should
solidify all the data on the long-term effects of
institutionalization regarding thousands of cases.
In my one sample, which I have seen, which has been
reported, of over 1,500 internationally adopted children, every
one of them were informed by their adoption agency that they
were healthy. All 1,500 of them were not healthy.
I broke down the statistics in terms of by numbers. But if
we were to look at approximations, 50 to 60 percent of the
children had long-term chronic problems; 20 to 30 percent had
refractory or chronic difficulties that would require lifelong
care and probably a lack of independence on the part of the
child; and less than 20 percent of our sample, which is
corroborated now with an additional sample that I have provided
from Emory University, since they have also done recent data
collections, show that the children were able to be resilient.
Again, sir, all of the children were advised by their
agencies that they were healthy. The statements that were made
consistently to me from the families, since I have had the
opportunity to review a modicum of medical records, that to
disregard the medical records, the children will be fine, they
are slightly delayed, they need a loving home, they need care,
health, hygiene, and everything would be fine.
This turned out to be absolutely incorrect, at least in our
assessment now of the older children, since what we are finding
out about the long-term effects of institutionalization, from
nutritional, medical and psychological neglect, which I have
supplied some of the most up-to-date research from researchers
across the country who would corroborate the findings, is that
children from internationally adopted settings, regardless of
age, are deemed a very high-risk population and require very
special families to handle these cases.
In my work with Romanian Secretary of State Tabacaru, he
recommends that every child out of Romania receive a label as a
handicapped child or a child at risk for delays.
Some of the other critical issues that seem to come about
is that the families were grossly ill prepared, overwhelmed. I
have dealt with families who divorced, went bankrupt. Many
relinquished their children. The majority of the families were
in states of despair and depression, where they did not know
how to deal with the situation of a, quote, healthy child.
All families passed the home study. In my years, 20 years
of practice, I have yet to see a family fail a home study.
Several of the families that passed home studies were active
alcoholics, drug addicts, out of prison, financially ill
prepared, unemployed, and so forth and so on, where they were
clearly not afforded a proper home study or psychological
evaluation, which has, for the most part, been deleted as a
critical part of the home study.
I have now been called upon to be a participant in numerous
litigations against agencies. I have served as an expert
witness several times, and right now I am involved in eight
different litigations against 10 different agencies.
So, in summary, sir, there seems to be quality control over
the preparation for the families. The families are very ill
prepared. There seems to be some misinformation provided to the
1,500 families who had, quote, healthy children, when all were
impaired at some level, with many of the families wondering why
they would pay so much money for a handicapped child.
Thank you very much for allowing me the opportunity to
testify.
[The prepared statement of Dr. Federici follows:]

Prepared Statement of Dr. Federici

I, Dr. Ronald Steven Federici, am a Board Certified Developmental
Neuropsychologist and expert in severely delayed children, particularly
children from post-institutionalized settings. I have been in
professional practice for 20 years and have evaluated approximately
1800 adopted and internationally adopted children. I am regarded as the
Country's expert in the neuropsychological evaluation and treatment of
the post-institutionalized child and lecture nationally and
internationally on this topic. I am the author of ``Help for the
Hopeless Child: A Guide for Families (With Special Discussion for
Assessing and Treating the Post-Institutionalized Child)''. Also, I am
the parent of six internationally adopted children; four of which
reside with us in the United States and the other two I raise in their
home country of Romania in which I maintain legal guardianship.
I have been evaluating internationally adopted children since
early-mid 1980's to present. I have evaluated approximately 1800 post-
institutionalized children and have collected extensive data which is
now being reviewed and incorporated into a major research project with
Dr. Dana Johnson at the University of Minnesota and Dr. Patrick Mason
at Emory University. My preliminary data is referenced in my book and
will be further outlined in my summary testimony.
Families come to see me from all over the United States and now
England and Ireland in order to receive my expertise in developmental
neuropsychological evaluations. Virtually every family who has come to
see me was informed by their adoption agency that their child was
either ``healthy'' or had ``mild developmental delays which would
improve with a loving and nurturing family''. I have reviewed thousands
of medical and psychiatric records on these post-institutionalized
children and have also heard thousands of the exact same story from
families who have adopted regarding their experience with their
international adoption agency.
There is a very important point to be made here regarding the
entire international adoption process, even prior to the child being
placed. In my 20 years of practice and, most recently, the extensive
work with internationally adopted children, I have yet to see a family
fail a ``home study'' which was provided by the agency. For example, I
have a family in which both parents were active alcoholics and in
treatment, but were allowed to adopt two children. When I confronted
them how they passed the home study, they openly informed me that their
adoption agency told them ``we just won't put that in the home study''.
I have many other cases in which it was clear one parent was mentally
ill, or both had significant emotional and marital problems but yet
passed the home study. I even have one case in which the father was out
of jail for sexual offenses and passed the home study in order to adopt
a child from Russia. Therefore, what is the purpose of a home study if
it does not measure or adequately assess any psychological domains of
the perspective parents or the agency will go as far as omitting
important information.
Specifically, all of the families who have come to see me have felt
at the end of their patience and totally overwhelmed and frustrated. By
the time families make it to my office, they have seen multiple medical
and psychiatric providers who still have not been able to reach a
conclusion or consensus regarding the type of illness or damage to
their child. The families have consistently told me that they have
brought their concerns to their international adoption agency, but have
rarely--if ever--received any type of support, encouragement or even
proper referral to those of us who are designated experts in
international adoption medicine. Actually, many of the families were
told to avoid specialists such as myself or others across the country
as ``we would only find a problem with their child which was not true
as the child just needed more time and love to adjust''.
Most families sought out my services as well as specialty services
from other international adoption specialists through the Parent
Network for the Post-Institutionalized Child (PNPIC), Friends of
Russian and Ukranian Adoptions (FRUA), word of mouth or by reading
various articles I have published or my recently published book.
Additionally, families with damaged internationally adopted children
flock to conferences sponsored by the Parent Network which have now
totaled over 17 across the United States and in the United Kingdom. In
these conferences which I have co-sponsored and lectured, rarely do we
see international adoption agency personnel. Actually, agencies avoid
these conferences and avoid dealing directly with the significant
problems that many post-institutionalized children experience.
In my preliminary research statistics, based on a sample of 1500
internationally adopted, post-institutionalized children, with an
average age of 4.2 years and an average time in the institution from
24-through-84 months, of the adoption agencies informed the families
that the children were ``healthy or only mildly delayed which would
improve with a loving family''. The medical records clearly indicated
that the child showed high risk pre- and post-natal factors such as
fetal alcohol exposure, prematurity, nutritional neglect, low birth
weight, or just the damaging effects of living in a deprived
institution. Also, there are frequently uncertain ``medical diagnoses''
put on the child's records such as perinatal encephalopathy, hypoxia or
various other unusual terms. While the medical experts consistently
state that these Eastern European diagnoses might not mean anything,
caution is still provided to the parents. International adoption
agencies frequently tell the parents to ``disregard the medical records
from the country as they have to put something down in order for the
child to be adopted out''. We are now finding that many of the true
medical records may lack clarity or sophistication in diagnostic
nomenclature, but are in fact correct in defining a child who is at
high risk or ill at some level.
The neuropsychological outcome factors of these 1500 children
yields the following:

1. 450 or approximately 30% of the sample had severe
neuropsychiatric disorders such as mental retardation, autism,
fetal alcohol syndrome, or chronic and long-term disabilities.
2. 750 or approximately 50% of the sample displayed mild-to-
moderate learning disabilities and developmental disorders
which required life-long special education, medical and
psychiatric interventions.
3. 375 or approximately 20% of the sample displayed
relatively ``clean'' or benign neuropsychological and
psychological difficulties which would continue to improve over
the course of time and with the appropriate medical,
psychological and educational interventions along with routine
acculturation.

Therefore, 80% of the children I have evaluated whose families were
told by their agency that they were ``healthy'' were, in fact
neuropsychiatrically impaired and would pose a financial and emotional
burden to the family for life. I fully realize that families come to me
for evaluation of problems, but if one provider such as myself has seen
so many impaired internationally adopted children, there must be
definite problems in the entire international adoption process
beginning at the time of the child being identified in their home
country (grossly inaccurate medical and psychiatric assessments).
Additionally, it is absolutely inappropriate for international adoption
agencies to tell families who are adopting children from such high risk
countries such as Russia, Romania, Bulgaria, other Eastern European
countries, India as well as Central and South America is that ``all
children need is a loving and stable home and time to adjust''.
Many of the agencies have recently published their ``research and
surveys'' regarding internationally adopted children. In the most
recent one completed by a Washington, D.C. agency, they touted that
only ``less than 10% of the children had problems and that most were
doing well''. Professional researchers and critics have totally
disregarded these surveys as they are no more than ``content surveys''.
Most families are happy they have a child which is the target of these
surveys, but there is no real mention or assessment regarding the level
of disabilities. Emory University International Child Clinic and the
Parent Network for the Post-Institutionalized Child are now conducting
a more professional national survey and finding completely contrary
results from the Washington, D.C. based survey. It is very clear that
proper professional evaluation of the internationally adopted child
indicates that these children are a ``very high risk population''. Just
for the Senate hearing records, I offered a modicum of professional
input and proper neurological and psychiatric assessment surveys to the
Washington, D.C. adoption agency who published the recent ``contentment
survey'' that I am sure the agencies will discuss. I spent ample time
in helping them formulate a proper research survey, but was informed by
the Director (following a presentation regarding neuropsychological
work with post-institutionalized children) that if ``she were to tell
families everything that I have presented or given to their agency,
that no one would adopt''. This sums up the issue and clearly shows
that financial gain and increasing adoption numbers took priority over
quality assurance and protection of the perspective adoptive family.
The agencies maintain a ``wait and see philosophy'' and have rarely
recommended to my families immediate and aggressive evaluation and
treatment. Even when families take my neuropsychological or other
medical data back to the agency in an effort to point out that their
child is severely impaired or delayed, many agencies which I can
specifically name and identify, have told families to disregard my
evaluation and keep getting additional opinions with the hope of
finding the child healthy and discredit my findings or those of my
professional colleagues. It should be emphasized that by the time
families come to me, I am, in fact, the last opinion or the one they
count on the most based on my expertise and extensive experience with
the post-institutionalized child.
I am an Honorary member of the Romanian Department of Child
Protective Services and President of the Romanian Challenge Appeal
which is an international humanitarian aid organization. I have over 30
medical specialists from all disciplines who have worked in Romania
evaluating children in institutional settings. I have visited
institutions all over the world, particularly Romania, and it is very
clear that any child residing in such a deprived environment can and
must be labeled ``high risk'' due to the multitude of environmental,
medical, nutritional and deprivation risk factors which international
adoption agencies grossly minimize when the families are in the initial
stages of international adoption.
A vast amount of my families have informed me that, when they went
to the country to pick up the child, it was very clear that the child
was sick and no where near the ``statement of health'' provided by the
international adoption agency. Many families have also informed me that
their child was switched at the last minute, or that their child was so
sick that they doubted he or she would make it home. Furthermore, many
of the families who adopted older children found the child to be
completely out of control and were completely ill-prepared to deal with
a violent and out of control child for the trip home.
I have served as expert witness on several high profile cases such
as the murder ease in Colorado where the mother murdered her
internationally adopted toddler (Polreis case) in addition to the Thorn
case where the parents were arrested in New York for allegedly abusing
their two Russian toddlers who were out of control on the plane. I have
been asked to serve as an expert witness multiple times by families
filing suit against their international adoption agencies. In the cases
I have participated in, international adoption agencies withheld or
fabricated records, blatantly lied to the families regarding the health
status of the child, or were involved in some type of scandal between
the U.S. agency and the overseas NGO. I have personally witnessed
lawyers obtaining the true medical records on the children in which the
international adoption agency and NGO deliberately withheld. I have
seen cases settle for millions of dollars. I have seen families being
given a child who has Delta-D Hepatitis which is a terminal condition
when they were told the child was perfectly healthy and passed the
``exit medical examination'' in their home country in which the
hepatitis would have been picked up immediately if it were a legitimate
examination. In many of the cases, it was exceedingly clear that the
agency withheld valuable information from the families which would have
potentially changed their decision to adopt or prepare properly for
adopting a special needs child.
I have seen a multitude of families disrupt their adoption because
they were no longer able to care for the child's financial and
emotional needs. I have seen families separate and divorce, or engage
in abuse of their child because the child exhibited grossly out of
control and aggressive behaviors. I have evaluated children who have
severe attachment disorders, neuropsychiatric conditions, sexual
offenders, killers of animals within the home, and several children who
have attempted to murder their siblings, parents or commit suicide. I
have consistently watched families feel devastated and enraged with
their international adoption agency who had promised them a ``healthy
child''.
There are few, if any, international adoption agencies who have
provided adequate training for the high risk factors of the post-
institutionalized child. Follow up counseling or support from
international adoption agencies is virtually non-existent.
It has been my professional and personal experience that, when
confronted, international adoption agencies maintain strong denial,
deceit and manipulation when they are forced to deal with a family that
has a damaged child. This is not an isolated occurrence, but a
situation which has occurred thousands of times. I urge the Committee
to consult with the Parent Network for the Post-Institutionalized Child
(Thais Tepper and Lois Hannon, Directors), in addition to various other
support groups around the country for families with internationally
adopted children. It would also be worthwhile for the Committee to
review the statistics of Tressler Lutheran Services in Pennsylvania as
directed by Barbara Holtan. This program has handled many disrupted
international adoptions and specialized in placing these very difficult
children.
In summary, and as stated in my book, international adoption
agencies do a very poor job in preparing families for the high-risk
post-institutionalized child. They maintain a position of denial and
minimization regarding the damaging effects of institutional care and
sell families the fantasy that a ``good loving home and time will cure
all''. Yes, there are definitely many children who do well, but there
is a very large percentage of families with damaged children. If I,
myself, have seen nearly 2000 and the Parent Network for the Post-
Institutionalized Child has almost 6000 families having damaged
children, and other organizations having thousands of their own damaged
children and families, then there clearly is a need for better quality
control on the part of the international adoption agencies.
Furthermore, all of the families who have come to me have spent a
minimum of $15,000-$20,000 to adopt their child which turned out to be
special needs. As stated by the Romanian Secretary of State, Dr.
Cristian Tabacarn, a Romanian adoption should cost no more than $4,000-
$5,000. Families are instructed to carry over large volumes of cash in
``new bills'' by their adoption agency to hand to the overseas
coordinator. This statement I can verify personally as I am the parent
of six internationally adopted children and was instructed by my agency
to carry over large sums of money in new bills and with specific
denominations. There is no accounting for this money that is sent
overseas and it is very clear that United States international adoption
agencies are making vast sums of money on adoptions, even the ones who
turned out to be handicapped.
Agencies continue to resist working collaboratively with adoption
medicine specialists, families, parent support groups, post-placement
supportive programs. The problem continues in volumes as the number of
internationally adopted children rises each year. There is no quality
control or accountability that the agencies must be held to. There is
no standard of care, operation, financial accountability or, most
importantly, securing the most accurate, detailed and honest
information provided to the families. Families adopting are very
vulnerable and impressionable, and tend to believe the fantasy as
opposed to a painful reality which is often the case.
Despite numerous attempts on my part to educate and offer free
training to any and all international adoption agencies, I have been
discounted and under utilized. JCICS recently sponsored the first
``International Medicine Adoption Conference'', but their practices
continue as it was very clear that many of the agencies in the audience
did not want to listen to the potential risk factors as this would
limit their adoption numbers and profit. They asked for training and
guidance, but turn around and do the same unethical and insensitive
practices time and time again.
Several agencies are under lawsuit at this time for fraudulent
practice. I would be pleased to provide documentation of pending legal
cases ranging from Oregon to Ohio to New York to Washington, D.C. to
Florida to Texas to Arizona involving more than 10 different agencies.
I continue to provide expert testimony and life planning for many of
the children that I have evaluated that are severely impaired and for
families that are in the process of suing their international adoption
agency for fraudulent adoption practices. I have seen many cases settle
before the court hearing, but the settlement is ``sealed'' per the
request of the adoption agency, but I am aware of the settlement
amounts and the legal document which were so clear in defining fraud
and negligence. Currently, I have received requests from literally
hundreds of families who wish they had the opportunity to tell their
story to any governmental agency or regulatory body who may invoke some
type of quality assurance or control over international adoptions. This
is not just one or two angry families, but a very large cross-sectional
group of well informed families. Many of these families were hoping
their concerns would be heard at this type of Senate hearing.
Without some form of governmental controls and monitoring, the
problem will continue. International adoption agencies seem to have a
difficult time in agreeing on how to ratify the Hague Convention as it
is clear they do not want accountability or monitoring.
Any area of medicine would be held accountable for their action.
This is why we maintain a license which is subject to scrutiny by our
State Boards. International adoption agencies have a license, but are
not subject to any scrutiny or disciplinary action aside from the times
they wind up in court--which is on the increase. The more handicapped
or special needs internationally adopted children coming into the
country will continue to provide a challenge to the ill-prepared
family, their educational system, and to the medical and psychiatric
specialists trying their best to deal with the problems. Most
importantly, the financial strain on the families can and will result
in more disrupted adoptions or the child receiving less than optimal
services.
With all of these factors in mind, it seems imperative that a
strong governmental position be taken regarding international adoption
agencies. Oversight, regulation, control regarding adoption practices
and financial accountability is of paramount importance.