Prospective viewers who believe they have seen enough scary movies about evil children to last a lifetime will be forced to eat their words after watching "Orphan," a deliciously macabre humdinger of a horror film that puts a skin-crawlingly ingenious spin on what may seem at first sight like hackneyed material. As the idiom goes, the devil's in the details, and director Jaume Collet-Serra (2005's underrated "House of Wax"), along with astute first-time screenwriter David Leslie Johnson, are certainly up to the challenge in twisting expectations while building upon critical elements, like character development, a palpable foreboding, and provocative subtexts, often missing from modern mainstream genre fare. Once all the mysteries are sorted out and revealed, it is safe to say no one will be able to claim they have seen this picture's devious bag of tricks before.

Kate Coleman (Vera Farmiga) has been having nightmares of the stillborn birth of her daughter, masked doctors and proudly videotaping husband John (Peter Sarsgaard) cheerfully going about the delivery as if it were normal to present a mother with the shriveled, blood-drenched corpse of her new baby. During her wakeful hours, Kate's life isn't quite so traumatic. A dedicated mother to son Daniel (Jimmy Bennett) and mostly-deaf daughter Max (Aryana Engineer), Kate is a recovering alcoholic one year sober, visiting a therapist (Margo Martindale) every week and attempting as best she can to make amends for her mistakes and move on with her life. Still, Kate senses that there is a missing hole still waiting to be filled, and her and John's decision to adopt sounds like a good way to do that.

Upon visiting the St. Mariana Home for Girls, Kate and John are drawn to Russian-born 9-year-old Esther (Isabelle Fuhrman), keeping to herself as she practices her painting skills in an otherwise empty upstairs classroom. Three weeks later, Kate and John are welcoming home the newest addition to their family. Extremely well-mannered and insisting upon wearing dressy clothes and ribbons in her hair and around her neck at all times, Esther is a little quirky, but that is to be expected for a child who has had such a tough life. The more time Kate spends with Esther, however, the more she begins to question how little they actually know about her and her past.

An unnerving psychological thriller with the atmospheric elegance of classics like 1968's "Rosemary's Baby," 1973's "Don't Look Now," and 1980's "Dressed to Kill," "Orphan" is masterful in its blends of style and substance, violence and mayhem. With the exception of one or two predictable jump scares, director Jaume Collet-Serra bypasses the negative trends and clichés that tarnish most studio-produced horror filmmaking and instead concentrates on the very real struggles, both internal and external, of its characters as they are faced with a terrifying mounting situation. Because Collet-Serra spends time with the Coleman family and all the different relationships within it—there is a beautiful bedtime scene, so gentle and poignant, where Kate reads a children's book to Max that explains what happened to her deceased younger sister—the viewer feels genuinely invested in them by the time Esther enters the equation.

For a while, Esther is utterly charming, a dream come true who is well-behaved, wise beyond her years, and delights in singing "The Glory of Love." When she pushes bratty, mean-spirited classmate Brenda (Jamie Young) off the playground equipment, the viewer stays on her side; Brenda, we believe, had it coming to her, what with her snot-nosed remarks about Esther's wardrobe and her cruel destruction of Esther's Bible. With the torn-up shreds of the religious tome, a grave miscommunication between right and wrong is unleashed, if not literally than certainly between the lines and in the face of a spiritual teacher who ultimately become the first murder victim. This, it would appear, is not merely coincidence on director Jaume Collet-Serra's part. As Esther plays mind games with Kate, Max and Daniel, in their own private ways being seriously threatened and blackmailed with their lives, she moves all the closer to John, who doubts the severity of his adopted daughter's troubles and starts questioning his wife's own mental health.

From 1956's "The Bad Seed," to 1976's "The Omen" (skip the terrible 2006 remake), to 1992's "Mikey," to 1993's "The Good Son," to 2007's "Joshua," to the terrific 2009 British chiller "The Children," there has been no lack in motion pictures serving to turn the angelic innocence of childhood into examples of demonic manifestations and old-fashioned antisocial behavior. Superficially, "Orphan" does not break fresh ground except for in the graphic viciousness with which Esther is capable of. The trajectory of the plot goes about as expected up to a certain point, then reveals added layers heretofore gone unseen. Esther's surgical intelligence, from a scene where her sisterly bond with the hearing-impaired Max is revealed for the ruse it is to another scene where pre-teen Daniel is intimidated in ways unimagined, are destined to shock the viewer as much as they send a shiver down his or her spine. The cruelest actions, however, are saved for Kate, with Esther toying with her where she knows it will sting, pulling flowers in the family's greenhouse that signify the spirit of their late daughter and calling attention to the fact that her other children do not—and, in Max's case, cannot—share her love of music. The disappointments and regrets that go along with being a parent and raising children who aren't quite the fantasy picture of who you had in your mind are faced with an unblinking straightforwardness. So, too, is the prolonged aftermath of something as disturbing as losing a child during birth, and Kate's subsequent battle throughout between the love for her family and her own personal demons.

The performances are as impressive as the bold, sleek cinematography by Jeff Cutter (2006's "The Gridiron Gang") and frosty, snowswept Ontario surroundings (standing in for New England). Vera Farmiga (2008's "The Boy in the Striped Pajamas") brings both a ferocious desperation and heartbreaking fragility to Kate, a mother and wife whose protectiveness of her family is at odds with John's growing mistrust in her. As John, Peter Sarsgaard (2007's "Rendition") gives depth to a comparatively underwritten part that requires he doubt Kate's warnings about Esther. John's beliefs, while frustrating for the viewer, are also plausible; we must remember that from his point-of-view Esther has done nothing wrong and given off no signs to him that she is troubled. As the initially jealous, soon imperiled Daniel, Jimmy Bennett (2009's "Star Trek") racks up another professional turn from an already impressive résumé, and newcomer Aryana Engineer genuinely impresses as Max. Engineer, hearing-impaired in real life as well as in the picture, is a total natural without an ounce of kid-actor unctuousness.

The star attraction of "Orphan" also happens to deliver one of the most momentous examples of acting from a child performer in years. From her freckled, perfectly coiffed brunette appearance, to her flawless Eastern European accent, to her ability to switch from sympathetic to ice-cold to veritably creepy in the same breath, Isabelle Fuhrman is astonishing as Esther. Not merely a one-note villain, Esther is a complex creation whose motives are subject to interpretation and whose secrets, when discovered, do nothing if not haunt the viewer's conscience. Fuhrman understands the part through and through—all the more amazing for a 12-year-old—and presents a fascinating case study for a probably incurable diseased mind. If Linda Blair and Jodie Foster warranted Oscar nominations for 1973's "The Exorcist" and 1976's "Taxi Driver," respectively, then Isabelle Fuhrman deserves to follow in those same footsteps.

With Esther's artistic aspirations and preternatural sexual blossoming additionally paying off in disturbing ways by the end, the questions of who this girl is and where she comes from loom over the proceedings. The answers will dare not be revealed—the central revelation is as inventive and unpredictable as it is truly horrifying, reminding one of the effectiveness of seeing 1999's "The Sixth Sense" for the first time—but they shine a newfound light on all that has come before, demanding a second viewing in the process. Brave in the places it goes and more than commendable in its refusal to shy away from difficult, controversial subject matter, "Orphan" is hard to shake and impossible to deny its effectiveness. An original thought in Hollywood is rare in a world of borrowed ideas and remakes galore, but story creator Alex Mace, writer David Leslie Johnson, and director Jaume Collet-Serra have achieved just that. It's worth celebrating. "Orphan" stands proud and tall alongside Sam Raimi's "Drag Me to Hell" as this year's piece de resistance in American horror.