This follow-up study of 80 Romanian children showed that 16 (20%) of the children exhibited posttraumatic stress disorder (PTSD). The same children got scores in the clinical range on the Child Behavior Checklist (CBCL). These PTSD children could be differentiated from the remaining children by psychosocial but not by physical health variables. Children showing characteristics of PTSD stood out from the other subjects because of their scores on the Externalization dimension and excessive attention-seeking on the CBCL. The findings indicated that these Romanian adoptees exhibited survivor behavior. A substantial number of these adopted children require aftercare by adoption specialists from the time they arrive in Dutch families. It seems plausible that the high incidence of PTSD characteristics was related to extreme physical and social neglect occurring in the orphanages.