Many of the same factors that make Moscow an exciting place, full of opportunity for expatriates can also make it a nightmare for those foreigners bringing children with learning difficulties and physical disabilities.


School resources for students with special needs are nothing like they are in the West. Medication can be hard to come by and English-speaking doctors, counselors and therapists do not have the same degree of specialization.


Take Sylvia Naumovski, the mother of a 6-year-old boy who, since coming to Moscow three years ago, has developed attention deficit disorder, or ADD, a physiological condition that can hinder a child's ability to learn and cope. Naumovski said if she had known about her son Stefan's disorder before the family's departure from Canada, she would have reconsidered the move to Moscow.


"Yeah, I might have been inclined not to have come," she said. "It would have been a hard decision. Still, children with attention deficit disorder don't require a special education and I probably would have come anyway," she added, reflecting the opportunity that coming to Moscow presented.


Children with ADD typically require special teachers and medication. The drug most commonly used in the West is Ridalin, a medicine not approved for use in Russia, and so it is unavailable.


Children like Stefan and others who suffer from learning difficulties and physical disabilities like cerebral palsy are not uncommon in Moscow's foreign community. They pose a special challenge for parents who are forced to be more resourceful in meeting their children's needs than they would be in their home country.


"I think families would tell you that it has not been negative, they just have to do a lot of the footwork themselves," said Vicki Rinaldi, an American physical therapist in Moscow, half of whose clients are children. Foreigners "tend to be more helpful here and they tend to have more time to be helpful."


Rinaldi said she sometimes spends two or three hours working alone with children suffering from conditions like cerebral palsy, while in the United States most clinics offer sessions no longer than 45 minutes to an hour. But, she said, "What they can't get here, which they can get at home is total care."


Because the number of foreign children with learning difficulties and physical disabilities is fairly low, Western specialists are rare, and neither of the two biggest English-language schools have special classes just for those students.


The Anglo-American School comes closest with a resource teacher, Marian Batten, who works with students from prekindergarten to sixth grade, both individually and in small groups. She estimates about 10 percent of the 350 Lower School students have some sort of learning disability, a figure slightly lower than American school districts where she has worked. Batten attributes this to a process of self selection, in which parents of children with learning disabilities decide not to come to Moscow.


While Batten said life in Moscow is generally more of a challenge, she added, "I don't think school is more difficult for them here." Home life is often more important than school life in the development of what Batten called a child's "coping skills."


Dr. Ronald Swanger, an American pediatrician at Moscow's US Global Health medical clinic, said Western families with children requiring special attention usually face the most stress in the months just after they arrive in Moscow. This is when children require the most attention but parents have the least amount of time as they themselves get accustomed to new jobs and a new life.


"Most children are very flexible, but especially the attention deficit disorder children do not have that kind of flexibility when you pluck them out of one environment and plop them down in another," said Swanger. "There is typically a surge in hyperactivity."


Swanger advised parents to take care to maintain consistency in their children's lives by trying to keep the same eating, sleeping and studying habits.


For Rachel Prebble, a Moscow clinical psychologist who works primarily with expatriate children, learning difficulties are often aggravated by the living conditions in Moscow.


"A lack of space is the primary issue, and the other is safety where children can't just go out by themselves and walk the dog," said Prebble, a native of New Zealand who works through US Global Health and with children at the Anglo-American School. Children with physical disabilities face the problem of a general population that often seems to have little concern for their needs.


"Because in this environment you do not see as many people with [physical] difficulties, there is also the social stigma," said Rinaldi, the occupational therapist. "And the city is not set up for easy access for any disability. It is not easy for children: the ice, the snow, the steep stairs."


To help disabled children cope, parents sometimes hire a full-time aide to accompany the child to school. While this allows the student to attend regular classes, there is the danger, Rinaldi said, that the child may become overly dependent on the aide.


While Moscow is not a hospitable environment for the physically disabled or for those with learning difficulties, Rinaldi said there is a growing informal network of parents, teachers and clinicians who can help. One indication of the increasing awareness is an ADD support group founded in January by Kim Palchikoff.


The group, which meets twice a month, attracts parents of ADD children as well as adults. Adults with ADD are drawn to rapidly changing places like Moscow, Palchikoff said.


"The way Moscow is right now, it is actually a plus. People are needed who are very energetic and creative," said Palchikoff, an American who is writing a book about the Russian circus. "For a person who is a couch potato or a suburb person it is harder to adapt."