Jenny, a 4-year-old child adopted from an orphanage in St Petersburg, Russia, at 6 months of age, is seen for an initial office visit by a new pediatrician. According to the parents, she received poor nutrition and limited stimulation in the orphanage setting. During her first several months after arrival in her new home, Jenny avoided the gaze of her parents and looked away when they attempted to engage her in play or participation in feeding. She did not demonstrate any preference for her parents for several months. She appeared to be quite “aloof and solemn.” She was easily frightened by certain visual and auditory stimuli such as ceiling fans. By 1 year of age she spoke several words, followed simple directions, and walked. Jenny had difficulty tolerating many textures of foods. She often mouthed inedible objects during her second year of life and performed repetitive behaviors including dumping and filling containers. She was clumsy for her age. Her parents felt that she was “on the fringe of the family.”
Jenny received occupational and speech and language therapy at a functional feeding program that addressed her food intolerance and oral sensitivity. During her third year, defiance, noncompliance, and anger occurred frequently. She often placed herself in dangerous situations. She burned her hand and lower lip on a light bulb after being told to stay away from it. She frequently ate out of the garbage. Jenny was described as “highly verbal” and “superficially charming.” Jenny followed women other than her mother in public spaces and wanted to hold their hands and sit on their laps.
She began play therapy at age 3 years, while her mother received individual counseling with another therapist because she was having difficulty “bonding with Jenny” and felt rejected. At age 4 years, Jenny is described as …