About 1,600 Russian children found adoptive families in the United States last year, according to the National Council For Adoption. Most of the adoptions have been successful, but the few children who live with an array of psychological and behavioral problems can tear families apart. One family, requesting that its last name not be used to protect the privacy of its sons, went so far as to terminate their parental rights.
After struggling with infertility, Lori and Tom said adoption seemed like the natural next step.
"We did a lot of research," Lori said. "We were full of hope and encouragement."
After successfully adopting their first son from a Russian orphanage, the Minnesota couple went back nine months later for another child, Joe. But this time it was different.
"He was in an orphanage -- a special needs orphanage -- and all the children in that orphanage, the children were shrieking," Lori said. "There was something wrong immediately with that environment."
Once they returned to the United States, Lori said, Joe hurt the family pet, attacked his two brothers and threatened to kill his family.
"He called me upstairs in a very shrill voice, and I knew something was wrong," Lori recalled. "And I went up the stairs and I found the light on, and I looked, and on the floor right by my bare feet there were pins that were sticking up … out of the carpet waiting for me to step on."
Joe was diagnosed with fetal alcohol exposure and reactive attachment disorder, or RAD, a rare but serious condition in which children can't bond and instead lash out at their parents. RAD is rare, not exclusive to adopted children and is caused by abuse and neglect in the earliest years of life. (CLICK HERE for more on RAD from the Mayo Clinic).
"Most individuals who have severe RAD, who are from an adopted background, are likely born to women who used some substance, whether it's alcohol or drugs," Dr. Jane Aronson, a New York City pediatrician and international adoption specialist, said. "I think those kids likely had organic brain syndromes."
"It was sort of like a nightmare," Lori said. "We were consulting numerous doctors and therapists, and our church; our private insurance ran out, and then we had to go to the county for help."
After an exhaustive search for help, Lori and Tom made the agonizing decision to give up their parental rights to get help for the son they say they still love.
But they learned last week that Joe had brought a gun to school. He is now at a juvenile detention center, accused of making threats.
"We didn't just all of a sudden make a snap decision," Lori said. "We made a decision for the safety of our other children and for our family. That's really the bottom line in this whole thing."
Jodi Bean, from outside Salt Lake City, understands the struggle. She and her husband adopted Victoria from an orphanage in Belarus when she was 4 years old. Abandoned as an infant, Victoria had never known a mother's love.
"When I gave her her own room, her own clothes her own bed and all the love that we had to offer her, I didn't know she wasn't even capable of accepting those things," Bean said. "The harder I tried, the more she pushed me away. It was complete rejection."
Victoria continued to act out, even threatening to kill her mother.
"She was very manipulating, very sneaky, very defiant," Bean said.
A doctor diagnosed Victoria with reactive attachment disorder, but unlike Joe, Victoria, now 9, has responded well to counseling. Part of her treatment includes horse therapy.
While Victoria is making progress, there are still tough days.
"We've made connections, when she chooses to let go of the fear and to trust we have really great bonding moments," Bean said. "I love her more than I ever thought possible."
ABC News' senior health and medical editor Dr. Richard Besser cautioned that cases like this are atypical.
"Eighty to 90 percent of adoptions remain intact and successful," Besser said, although disruption rates among special needs adoptions and older child adoptions are higher.
An adjustment period is normal after any adoption, but parents need to understand "the difference between an adjustment and a true adjustment disorder," Besser said.
When children are adopted from Eastern European countries, "there's a very high rate of children being in institutions before being adopted," Besser said.
Living in an institutional setting is a risk factor for attachment problems, growth delays and difficulties in social and cognitive development.
There is also a "high rate of mothers using alcohol during pregnancy," which can lead to problems later on.
The most important thing, Besser said, is for anyone considering adoption to do his or her homework and have realistic expectations.
"You don't want to go into adoption lightly," Besser said. "There are things that you can do."
Talk to Other Parents
Besser advised seeking advice from other adoptive parents.
Identify Community Resources
Form a support network that includes friends or a support group. The more support you are getting, the more you can give to your child. Besser also suggested looking for a pediatrician who has experience with adopted children.
"They know what's available in terms of counseling" he said, and can help guide you through difficult patches.
Learn as Much as You Can About That Child
Besser said to do everything you can to find out "what was their life like before they came to you."