Most adoptions from Russia end well, experts say. But a series of highly-publicized cases of parents who say their Russian children come with several mental and behavioral issues, some to the point of extreme violence, have cast a pall both on the country's orphanage system and the American parents who sign up to take on the children.
Virgnina mother Peggy Sue Hilt is serving 25 years in prison for the 2006 beating death of her 2-year-old, Russian-born daughter Nina. Hilt told ABC News' "20/20" that Nina was impossible to handle from the beginning, withdrawn and prone to banging her head against things.
Hilt began drinking heavily in secret and one day, finally lost her patience.
"Nina picked up a fork off the table and went towards [her sister] with it, and I saw red," Hilt said. "I grabbed her and I snapped. I hurt her. I didn't mean to hurt her. Then I kicked her with the side of my foot and told her to get up and then I put her up in her bed and struck her repeatedly."
Fifteeen cases of Russian children murdered by their parents have been recorded in the United States since the early 1990s, causing concern on the part of Russian and American officials.
While there is no behavior that can excuse child abuse, Pertman said orphans in Russia are often institutionalized and, as a general rule, institutionalized children suffer higher rates of attachment and behavioral disorders.
"You can not live in an institution for years and suffer no consequences," he said. The answer, he said, lays with foreign countries minimizing damaging environments for the children and U.S. adoption agencies doing a better job of vetting and education potential adoptive parents.
"Of course your heart breaks for this child," Pertman said of Artyem. "People should not get the impression that all Russian kids have these problems."
According to government statistics, the number of Russian children adopted to U.S. families has sharply declined in the last 10 years, down from a high of 5,862 in 2004 to 1,586 last year.
ABC News' Kari Pricher Scott Mayerowitz contributed to this story.