Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Tuesday, June 4, 2013

Apples, Oranges, Red Herrings, and Russian Adoptees' Deaths

In the articles by Tina Traster that I commented on a few days ago, and in many other recent places like http://www.csmonitor.com/World/Europe/2013/0304/As-emotions-over-US-Russia-adoptions-intensify-a-rift-widens-into-a-chasm, writers have stated that the proportion of adopted children who have died of abuse or neglect in Russia is greater than the proportion of children adopted from Russia who have died similarly in the United States.

It’s very reasonable to compare those two proportions rather than simply looking at absolute numbers of deaths in the United States. It’s well understood, unfortunately, that there are some populations (like physically handicapped children) that are at greater risk for abuse or neglect than others. If we could identify Russian adoptees as such a population, we might be able to focus help and resources for their adopted families in ways that would help prevent abuse and neglect at all levels--  not just the amount that is likely to be fatal. This would be a good idea for both Russian and U.S. adoptive families.

But how do we make this comparison? First we have to decide whether a particular comparison would be looking at “apples and apples” or “apples and oranges”. This is not necessarily easy to do, and different comparisons can give us different answers.

One approach would be to look at how Russian adoptee deaths in the U.S. compare to mortality rates for all children in the U.S. There are records of adoptions from Russia to the United States , estimated at about 60,000 children over the last twenty years. Of these, 19 have been documented as dying under circumstances characterized as neglect or abuse. (I believe that it is simply sensationalism to describe such deaths as all having been “at the parents’ hands). The number of deaths considered to be from natural causes or as the result of accidental injury has not been publicized, but it is possible that in that number are “hidden” deaths that might have been more accurately assessed as due to neglect or abuse. I might point out, too, that the custom of changing adopted children’s birth certificates to show their adoptive parents as birth parents may prevent identification of a dead child as being Russian-born, and unless the parents disclose the circumstances, a child adopted as an infant may not have been known as an adoptee. In any case, given the documented cases alone, the rate appears to be about .33 deaths per 1000 adoptions. The mortality rate for children from birth to 19 years in the United States is about 18 deaths due to accident or homicide per 100,000 , or .18 per 1000 , a little over half the rate of deaths of Russian adoptees. For homicide alone, the rate is about .04 per 1000.  (The figures I am using here do not show deaths from neglect, but this is the best I can do, I think.) So, it does appear that Russian adoptees have died at a higher rate  from non-natural causes than all children in the U.S.

How about the comparison of Russian adoptee deaths in the United States to Russian adoptee deaths in Russia? Again and again, journalists have stated that 170,000 Russian children were adopted by Russian families in about the last twenty years, and that 1220 died from abuse or neglect. This would obviously be a high death rate and strikingly different from the death rate reported for Russian adoptees in the U.S. But the figure 1220 seems to have come from an erroneous or ambiguous reading of a document (http://www.usynovite.ru/f/experience/book/book.doc) that refers to records of a preliminary study on deaths of children and incidents of ill treatment of orphans, with 12 out of 1220 dying in situations where guardians or adopters were at fault. There were also 116 who were seriously harmed, with 23 of those suffering harm through the fault of their caregivers. But who were the 1220 we began with? It is far from clear whether they were a group who were all harmed in some way, or whether they were simply a population sample drawn in an attempt to understand rates of harm without investigating all 170,000 cases. Whichever it  may be, it’s clear that any calculation of rates based on these data is what we call a PFA number – Pulled From the Air. There’s no easy way to tell whether this number represents apples, oranges, or some other comparison fruit.

At the beginning of this post, I suggested that making appropriate comparisons could be a way of deciding whether groups of children were for some reason at unusually high risk for mistreatment or other problems when in adoptive families. Knowing that risk factors were present could enable us to channel extra help to those families and to perhaps to prevent some problems. But I don’t think the intentionl of various journalists has been to make comparisons in order to reach that goal. Rather than dealing with apples and oranges, I think most of this discussion has actually been about red herrings. Rather than considering why Russian adoptees have died of abuse and neglect in the United States, some journalists have done their best to distract from the real issue by concentrating on blaming the children, the orphanages, Russian adoptive families, the Magnitsky Act, etc.

Let’s get back to the actual problem. The deaths of Russian adoptees are only one facet of the problem of systematic maltreatment of children, whether adopted from abroad or from the U.S., or whether oppositional or in some other way displeasing to their parents. Such maltreatment can result from mistaken beliefs about early development like those espoused by Tina Traster. We need to stop apportioning blame and start examining with care the expectations that adoptive parents carry into their new relationships. Only in that way can we begin to prevent more family tragedies.






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