Charlotte, N.C. ? Nearly six years ago, Pat Amon traveled to Russia to adopt. She returned with a boy and a girl, and dreams of giving them a happy American childhood.

She knew the years ahead wouldn’t be easy. Children from orphanages can have developmental delays, physical shortcomings, mental difficulties. Still, she believed problems could be remedied.

Pat underestimated the challenges. International adoptions in the United States have tripled since 1990, to more than 20,000 a year. The majority have happy endings. But Pat’s ordeal, far from unique, offers a caution to anyone considering the process.

For years, Pat worked as an infertility nurse, witnessing the joy of women learning they were to be mothers. In 1999, after long consideration, she decided she wanted motherhood, too. She was 47 and unmarried. International adoption seemed the surest route. She made her first trip to Russia in 2000 and fell in love with Kathryn. Then named Elena, the 2-year-old was toddling around an orphanage in Astrakhan, in southern Russia.

When adoption officials pointed out a rosy-cheeked 3-year-old named Mikhail, she agreed to take him, too.

In May 2001, she brought the children to the south Charlotte, N.C., home she shared with her partner. Kathryn was 3; Mikhail, 4. (Pat changed Mikhail’s name, but requested it be withheld to protect his privacy.)

Beginning problems

From the start, Kathryn was difficult. While Mikhail hovered near Pat and chattered in Russian, Kathryn spent hours running through the house and balked when Pat tried to cuddle. “I would hug her. She would butt me.”

At 3, Kathryn hadn’t begun talking. Experts diagnosed motor and language delays. They noted that she avoided eye contact, hit her face when frustrated and rocked or butted her head against Pat when upset.

Over the next several years, Pat read books and saw psychologists to learn parenting techniques. She got Kathryn therapies – speech, occupational and sensory integration. She took her to ballet to improve her coordination.

But problems persisted. She remained defiant and aggressive, ignoring her mother, hitting her brother and the family’s dogs, head-butting a friend during a play date.

Kathryn continued to pull away when Pat offered affection or attention. When Pat ignored Kathryn, however, the child sought her out. Such behavior suggested reactive attachment disorder, found in children who’ve spent early years in institutional or foster care. It’s characterized by hostility, lying and an inability to trust adults.

By the time Kathryn entered kindergarten, she was taking an anti-psychotic to control aggression and an attention deficit disorder drug. In 2005, after an epilepsy diagnosis, she began taking an anti-seizure drug, too.

Why was Kathryn so troubled? Pat could only guess. Kathryn had been happy and affectionate in her orphanage. The one warning sign in her records – a cerebral palsy diagnosis – was deleted after a U.S. doctor reviewed a video of Kathryn and ruled it out.

Still, Pat knows she ignored red flags. One adoption official had told Pat not to adopt the girl.

“I just had this gut feeling there was something they weren’t telling me,” Pat says. “But did I ask? Of course not.”

In 2006, Kathryn turned 8, still small for her age, but with a growing list of diagnoses that included attachment disorder, oppositional defiant disorder, epilepsy, mild mental retardation, attention deficit disorder.

She was getting worse. Calls from school became so frequent that Pat quit her nursing job.

No longer mother

Over the next three months, Pat requested therapeutic foster care for Kathryn. Pat also lobbied to send Kathryn to a program in New Mexico that treats attachment disorder. But a psychologist concluded she would be best treated at home.

In October, a foster mother was finally lined up, then fell through. With Pat threatening to give up parental rights, her case manager found a family through Lutheran Family Services. Days later, Pat learned someone had erred: Lutheran Family Services didn’t have a contract with the county for therapeutic foster care. Kathryn needed to return home.

No, Pat said. I won’t take her back.

No one keeps statistics on failed international adoptions. Experts say they’ve increased as adoptions have boomed. Some criticize parents who give up their children, but others are reluctant to judge.

“Walk a mile in a parent’s shoes before you say something like that,” says Dr. Dana Johnson of the University of Minnesota’s International Adoption Clinic.

After more than five years as Kathryn’s mother, Pat signed papers giving up custody and handed over Kathryn’s Russian birth certificate. Today, Kathryn Amon, now 9, is in DSS custody. Pat is no longer her mother.

Kathryn lives in a therapeutic foster home, Pat says, and could be adopted. Because of confidentiality rules, county officials won’t discuss her case.

Pat continues to second-guess her decisions. She feels guilt and grief. And relief.