Elizabeth Keagy & Barbara Rall. Handbook of Adoption: Implications for Researchers, Practitioners, and Families. Editor: Rafael A Javier, Amanda L Baden, Frank A Biafora, Alina Camacho-Gingerich. Sage Publication. 2007.
The nature of adoption has changed over the past several decades due to several social and legal variables. A major factor that affects contemporary adoption is the decline in the number of healthy, White babies being placed for adoption domestically due to a greater societal acceptance of single mothers combined with the increase in White couples and single people interested in adoption (Zamostny, O’Brien, Baden, & Wiley, 2003). There has also been federal and state legislation focused on moving children from foster care to adoption, specifically the passage of the Adoption Assistance and Child Welfare Act of 1980, which focuses on the permanency and continuity of relationships for children rather than multiple foster placements; and the Adoption and Safe Families Act of 1997, which seeks to lessen the amount of time a child stays in foster care and expedite the adoption of children who are in the public welfare system when parental reunification is unlikely. This legislation has greatly influenced the number of children with special needs being placed for adoption. Special-needs children are defined as children who are adopted at older ages, from racial or ethnic minorities, members of sibling groups, or those who have special emotional, behavioral, developmental, or medical problems. These are often children in foster care who seek permanent homes because they cannot be reunited with their birth parents due to neglect or abuse. The shift toward an increasing number of special-needs adoptions “has been accompanied by an increased rate of children and families experiencing post-adoptive problems (i.e., financial, medical, behavioral, legal)” (Reilly & Platz, 2003, p. 782). To assist families who adopt special-needs children, it is essential that specialized pre- and postadoption services designed to address their specific needs are available. We will examine the unique challenges that may be faced by these families and what can be done to support them to ensure positive outcomes.
One of the theoretical perspectives on adoption adjustment that may be particularly relevant for children with special needs is attachment theory. Originally proposed by Bowlby (1969, 1973, 1980), this theory details the parent-child bond that provides a basic sense of security for the infant and is essential for healthy psychological adjustment throughout the life span. The child develops a set of internal expectations about him- or herself, others, relationships, and the world. If the parent or caretaker responds to the child’s needs, the child develops trust in the world and is able to develop self-esteem because he or she knows that he or she is important. If the caretaker is unreliable, as with children who suffer neglect or abuse, the child develops a model of the world as untrustworthy, which will affect his or her ability to develop future relationships.
Challenges of Special-Needs Children
When an older child is adopted, there may be distinctive problems around developing a bond between the parent and child. “The trauma of the initial separation, impaired ability to trust, fears of repeated abandonment and other experiences typical in relinquishment and adoption can impede the development of healthy attachment” (McGinn, 2000, p. 289). An older child may have memories of his or her birth parents or of previous foster care placements, and there can be a profound sense of grief and loss that can interfere with one’s adjustment and attachment when placed with a new family. The child may have suffered neglect and abuse as well that can make the adjustment difficult (Brodzinsky, Schechter, & Henig, 1992). If early parenting was erratic or neglectful, the children may have negative expectations of how others will interact with them (Milan & Pinderhughes, 2000). Children who have histories of abuse also tend to have behavioral problems. These behaviors may previously have helped them cope with and adapt to their abusive home environment, but when these children enter a new home, their behaviors are viewed as challenges. It may be helpful to think of these behaviors as strengths that were vital to the child’s survival in a previous situation and use them as a way to better understand the child (Henry, 1999).
For instance, many special-needs children have suffered significant losses and abandonment, and they often exhibit avoidant attachment styles (McWey, 2004). They have learned to depend on themselves and have developed defenses for survival, which may manifest as behavioral problems, such as aggression or withdrawal. They believe that they must control caregivers to remain safe and so they may manipulate or intimidate (Hughes, 2004). These children may view new caretakers with mistrust and often have difficulty forming attachments. Helping foster parents and prospective adoptive parents understand attachment strategies and providing them with therapeutic skills may help them deal with any attachment-related difficulties more effectively. If parents do not understand that behavioral problems are the results of attachment difficulties, they may become alienated from the children and potentially provide less than optimal care (Tyrrell & Dozier, 1999). Attachment difficulties can also lead to disruptions in adoption, as evidenced in the following case of Peter, a 6-year-old boy, who was removed from his birth family at the age of 6 months because of severe neglect and spent most of his young life in foster placements. In fact, by the age of 6, he had already been placed in five foster homes where he did not have the time to develop any meaningful relationships with anyone. He now shows no fear of strangers and often wanders off in public places such as the supermarket. In each placement, Peter’s foster parents had hoped to adopt him but became discouraged when Peter refused to be held and cuddled or to differentiate between them and total strangers.
Awareness of the potential for attachment difficulties can inform foster care and adoption agencies when developing services. Individual counseling with these children can help because counselors work to promote a safe therapeutic environment so that the child can begin to develop secure attachments and learn to trust. The behavioral problems may lessen as a result (Hopkins, 2000; Hughes, 2004; McWey, 2004).
Important Steps to Be Considered with Special-Needs Adoption
One of the most important aspects associated with a special-needs adoption is preparation. Some research indicates that families were dissatisfied with the preparation agencies provided (Berry, 1990). This is an area that needs to be a particular focus of preadoption services. There are several components involved in the preparation process once a family has applied to adopt a special-needs child.
Initial Assessment
One of the first is the home study that is necessary for families to qualify. This involves an assessment of various aspects of the applicants’ lives such as social, employment, income, and health. They are required to explain their reasons for wanting to adopt and their expectations about life with a special-needs child. The applicant may also be expected to attend a series of group meetings to talk about the process of adoption.
Issues of Having Proper Information
There may also be meetings to share information about the child’s background (Sar, 2000). It is important that the adoptive parents have adequate background information on the child so they can realistically and adequately prepare for integrating the child into their lives. If parents are unaware of any abuse or trauma in the child’s past, they are unprepared to help the child cope with it and the behavioral difficulties that may arise. Some agencies may fail to provide background information to avoid alarming the parents or to avoid stigmatizing the child as damaged and destined for difficulty (Brodzinsky et al., 1992). Reilly and Platz (2003) found that a majority of families reported not receiving enough information on the child, and several stated that the child’s problems were more serious than originally reported. Kirby and Hardesty (1998) recommend comprehensive evaluations of older preadoptive foster children with the findings reported to social workers and potential adoptive parents to facilitate adequate placement, preparation, and intervention. Egbert and LaMont (2004) found that those parents who rated themselves as very prepared for special-needs adoption obtained adequate training and information and had a positive, supportive relationship with the agency. Those who rated themselves as very unprepared indicated that they were not informed of the severity of the children’s problems.
Maintaining the Right Expectations
Reilly and Platz (2003) found that parental expectations regarding adopted children had a significant impact on adoption outcomes. Despite their child’s reported behavior problems, such as anger, impulsiveness, defiance, and tantrums, the majority of families reported that the quality of their relationship with their child was good to excellent and that the overall impact on the family was positive. The more appropriate the parent’s behavioral expectations of the children were, the more likely the parents were to have nurturing, nonabusive attitudes about parenting and the more positive the impact of the adoption on the family. McDonald, Propp, and Murphy (2001) found that appropriate parental expectation was associated with stable placement and a positive assessment of the child’s impact on the family. Brodzinsky, Smith, and Brodzinsky (1998) also emphasize the importance of realistic parental expectations in successful special-needs adoption outcomes. Knowing that the risk of a difficult adjustment is a possibility can help parents have more reasonable expectations. This can be addressed in preadoption preparation services, so parents are aware of the challenges they may face. Parents should have access to accurate and comprehensive information about their child’s history and behavioral issues before, during, and after the adoption. There should be opportunities for ongoing education and support to help families develop skills to manage and cope with any challenging emotional and behavioral issues (Egbert & LaMont, 2004).
Proper Preparation and Training
One training program that focuses on parental preparation, called PRIDE, an acronym that stands for Parent Resource for Information, Development and Education, was developed by the Illinois Department of Family and Children’s Services and the Child Welfare League of America (2005) and is designed to prepare foster and adoptive parents to deal with the specific issues and behaviors of special-needs children. The 27-hour course, taught in nine 3-hour segments, is currently used in New Jersey, Texas, and numerous other states. The first two meetings present prospective parents with an overview of the philosophy of the state child welfare system with a focus on permanence for children. The differences between adoption and foster care are reviewed. Children’s connections with their birth families and what the ideal interim caregiver can provide are explored. Session three covers the developmental needs of children, attachment issues, and the effects of abuse and neglect on children. Session four focuses on the issues of loss and separation for all members of the triad. Many foster parents do not understand how a child can remain loyal to those who have abused or neglected him or her. The difficulty birth parents experience in regard to surrendering parental rights despite being unable to care for their child(ren) is also explored. Session five is devoted to strengthening family relationships and to helping children develop self-esteem as well as a personal and cultural identity. Session six covers discipline, and parents are assisted in developing alternatives to corporal punishment. The special issues of disciplining abused and neglected children are covered in this session. Session seven covers the continuation of family relationships. Birth parents can play a real or an imagined role in the child’s life. Prospective foster and adoptive parents must learn to speak positively, yet realistically, about the birth parents and the plans for the child’s future. Some children may be returning to their families of origin or to a relative. There may be ongoing contact with the birth family whether or not the child ends up living permanently with them. Visitation and ongoing contact can often be very challenging for prospective adoptive parents, particularly when the child returns from visits in a distressed state of mind. Even those children who will have no ongoing contact have fears and fantasies about their birth families. Some children believe it was their behavior that caused their move to foster care. Session eight focuses on planning for change. Unless the child is placed directly in a preadoptive home, a move back home or to another foster or adoptive family is inevitable. Each move causes another bonding break for children. Often, after a number of moves, children begin to feel that they will never find a permanent place. This feeling often leads to acting out early in the placement to get the move “over with” quickly before the child develops another attachment. The issues of sexual abuse, how they may manifest themselves in foster children’s behavior, and the risks to other members of the household are also explored in this session. Session nine summarizes the previous sessions and focuses on making the decision to become a foster parent. It can include a live panel of experienced foster parents, adolescents in foster care, and others who can bring personal experience to the prospective foster/adoptive parents. During the course of the training, video clips, role plays, guided imagery, overheads, flip charts, and genograms are used to illustrate various issues. Some states use volunteer foster parents to team teach the course.
As can be seen, there is a great deal of information involved in preparing for a special-needs child, and realistic and adequate preparation involves a series of tasks. A study conducted by Sar (2000) looked at the adoption preparation tasks of mothers who adopted special-needs children with an average age of 10.84 years to determine which tasks were most helpful. The following tasks were covered:
- Learning about the child
- Learning about the process of special-needs adoption
- Learning how the adoption would affect the family system
- Learning how to cope with the special needs of the child
- Learning how to prevent disruption
The mothers focused most frequently on learning about the child and found that participating in training to be an adoptive parent was the most helpful. Those mothers who evaluated their overall preparedness for adoption as high also provided a positive evaluation of life, family life, relationship with the adopted child, and the child’s behavior and reported less parental stress. These findings emphasize the importance of preadoptive services providing adequate preparation and education for new adoptive parents.
Let’s Not Forget about Stress
Stress is another important component when looking at special-needs adoptions and is an area that should be addressed in pre- and postadoptive services for these families. McGlone, Santos, Kazama, Fong, and Mueller (2002) conducted interviews with adoptive parents of special-needs children to determine the nature and extent of parental stress. They identified five categories of stress:
- Child characteristics
- Parent-child interactions
- Family cohesion
- Parental adjustment
- Adoption services issues
The child characteristics reported to be most stressful included behaviors such as lying, stealing, and aggression, both verbal and physical. Rosenthal (1993) also found that behavioral problems were the largest source of stress for families who adopt special-needs children.
Stressors identified by McGlone et al. (2002) related to parent-child interaction included the child lying to them, the child’s disobedience, and limit pushing. Family cohesion was also an area of stress. For families with birth children, there was fighting and teasing between the adoptive and birth children, and parents found it difficult to meet everyone’s needs. Parents had difficulty adjusting to the extra workload and new routine and had difficulty finding time for themselves. Stressors related to the adoption services were the perceived lack of adequate information about the child and the parents’ sense that they were rushed into the adoption placement. These results clearly indicate an elevated level of stress for new adoptive parents of special-needs children. This is a concern because “high levels of parenting stress may be a risk for potential disruption” (McGlone et al., 2002, p. 166). In a review of research findings on adoption disruption Westhues and Cohen (1990) conclude that adoption disruption is higher in special-needs adoptions than in infant adoptions and that the placement is more likely to disrupt if the child is older, if the child has a history of abuse, or if he or she exhibits emotional or psychological problems. Barth, Berry, Yoshikami, Goodfield, and Carson (1988) also report that older children and those with previous adoption placements are at greatest risk of adoption disruption.
Strategies to Reduce Stress
To reduce stress and potential disruption, adoption agencies should pay particular attention to parental stress levels and provide appropriate support. The preadoption assessments should look at the parents’ readiness to adopt a special-needs child. Interview questions should be geared toward assessing stress management skills and beliefs and expectations about parenting children who may have emotional and behavioral issues. If there are birth children in the family, it is important to address potential adjustment issues for those children to reduce parental stress. Lipscombe, Moyers, and Farmer (2004) found that difficulties between foster children and birth children were the primary reason for ending placement. Those parents were able to cope with a range of difficult behaviors but found it most challenging when the foster children had a negative impact on the other children in the household. Postadoption services should include ongoing support to monitor stress levels, and agencies must take action to connect families to counseling services for individual or family therapy if parental stress is high due to poor sibling adjustment, emotional or behavioral problems, or low family unity. Respite care can also be an effective strategy to help manage parental stress (McGlone et al., 2002). Active participation by both parents as well as effective communication skills have also been found to sustain a special-needs placement (Westhues & Cohen, 1990). Parents can also be empowered by experiential learning and modeling of effective parenting behavior (Sprang, Clark, Kaak, & Brenzel, 2004).
Many older children who are adopted have come from foster care prior to the adoptive placement. Research done with foster care families can also serve to inform adoption agencies about appropriate areas to focus on in pre- and postadoptive services. O’Neill (2004) found that children in long-term foster care who eventually received permanent placement felt a lack of power and control over their frequent moves, and their challenging behaviors were a way to exert control. They struggled with the effects of past neglect and abuse and found it difficult to learn how to be part of a new family. Some suggestions to help families include creating a structure and setting rules that are clearly explained to the children so that they can gain confidence in their ability to navigate their way in their new family. Consistency and open, honest communication can serve to provide a stable base so that adoptees can develop trust and secure attachments. Kenrick (2000) also stresses the importance of providing therapy for children who have been in foster care as a way to help them learn to cope with the repeated separation and change of multiple placements.
Stress When Placement is Not a Sure Thing
A unique situation that exists for special-needs children is that they may live with foster-adoptive parents instead of waiting for termination of parental rights if they are victims of abuse or neglect. The foster-adoptive parents hope to adopt these children but the birth parents have not yet terminated their rights and reunification attempts may still be in process. This uncertainty can create a wide range of issues of which prospective parents and social service agency workers must be aware. There can be a great deal of anxiety and uncertainty due to the perceived impermanence of the situation for both child and prospective parent. The child may also feel a great deal of insecurity and a weak sense of belonging (Triseliotis, 2002).
Edelstein, Burge, and Waterman (2002) stress that it is important that the prospective parents are aware of the legal risks associated with this type of placement, so that they can appropriately respond to the needs of the child as well as their own needs. There is the potential for threats to the adoption plan that can cause disappointment and anger or feelings of helplessness. The foster-adoptive parents must be aware of and acknowledge the negative feelings and anger they may have toward the birth parents. If there are continued visitations with the birth parent, the children often experience complex and confusing feelings. They may experience a conflicting sense of loyalty or protectiveness toward the birth as well as the potential adoptive parents and try to meet the needs of both at great emotional cost to themselves. They may fear losing the birth parents with whom they share a history even if it does involve abuse or neglect, but they also acknowledge the security and stability with the foster-adoptive parent. O’Neill (2004) found that despite years of considerable abuse and neglect, children who joined other permanent families expressed a need to maintain contact with their biological families. “Children may feel they are put in the position of making an impossible choice between an old attachment bond and the new experience of safety and consistency in a foster-adoptive home” (Edelstein et al., 2002, p. 116). This stress and worry often results in increased anxiety, acting-out behavior, temper tantrums, or withdrawal around visits. Counseling services for the parents and children should be made available during these times so all parties feel supported. The fact that many older children who are adopted have lived with their birth-family members for several years also raises the issue of open adoption with contact between the adoptive parents, adopted child, and members of the birth family.
Issues Related to Open Adoption
Special-needs adoptees are often older and have developed significant and meaningful relationships in their lives. These bonds could be with birth grandparents, siblings, aunts, uncles, cousins, or previous foster parents, and “openness may be crucial in minimizing further loss in their lives” (Silverstein & Roszia, 1999, p. 645). Open adoption allows the adoptee to maintain these relationships and can even serve to enhance attachment with the adoptive family. If the children feel that the birth family likes the adoptive family and supports the placement, they may feel that permission has been granted by the birth family to attach to the new family. If special-needs adoptees are able to preserve the connections they have already formed with members of their birth family or other significant adults, it can help them feel a sense of continuity and minimize the conflict of loyalty that may come with joining a new family. It is important that families understand that “children … are capable of forming multiple, differential, and significant attachments, and that the role one individual plays in another’s life cannot be replaced by another person” (p. 643). Maintaining open contact with those the child is close to can ultimately help minimize loss and trauma.
Continued contact with members of the birth family can also help adopted children move through the grief process because they are able to ask questions and obtain accurate information about their birth family. This may help them gain a better understanding of why adoption was necessary and dispel any fantasies they may hold of the birth parents. It can also help “eliminate the secretiveness and fear of the unknown that have proved so debilitating for some adoptees” (Brodzinsky et al., 1992, p. 188). Openness is also important in identity formation for special-needs adoptees. If they have ongoing contact with members of the birth family, they can integrate aspects from that family as well as the adoptive family to create a more complete sense of self (Silverstein & Roszia, 1999).
All members of the adoption triad can benefit from an open adoption. The birth parents may voluntarily relinquish their rights if they know they can maintain a relationship with their child and thus avoid long court proceedings. Adoptive families gain the opportunity to know their child’s history and accept their differences (Silverstein & Roszia, 1999). “Although open adoptions may challenge boundary establishment, they also can facilitate a sense of acceptance and belonging” (Elbow, 1986, p. 367). Andersson (2005) found that children in long-term foster care who had a significant relationship with at least one parental figure had good social adjustment and well-being as adults.
It is possible that circumstances exist that could deter openness in adoption, particularly if there was severe abuse and neglect by the birth family. The birth parents or members of the birth family could suffer from substance abuse or serious mental health problems that could lead to uncontrolled violence, which would also limit the contact they have with the adoptee. Court proceedings also have the potential to become adversarial, and the birth parents may be described in negative terms, for example as unfit or undeserving. This may dissuade the adoptive family from allowing contact with the birth parents, and they may disregard attempts of open contact by other members of the birth family because of their negative opinion of the birth parents (Silverstein & Roszia, 1999). It is important that adoption professionals make every effort to increase opportunities for safe contact and open communication between members of the birth and adoptive families for the sake of the child. “Openness can help promote the child’s ability to trust, feel optimistic about life, and establish positive relationships” (Silverstein & Roszia, 1999, p. 640).
Programmatic Intervention
If open adoption is the choice for these families, specialized pre- and postadoption services must be considered. Silverstein and Roszia (1999) designed a model for promoting openness in special-needs adoption that combines educational and experiential opportunities. It helps families learn about their personal values, beliefs, biases, and fears and about the adoption process and one another, and it hopes to encourage each to expand the boundaries of their families. Families are provided with adoption-specific information and are taught new skills to learn how to interact with people who may have different lifestyles and ways of relating. There may be a need for both the adoptive- and birth-family members to overcome their prejudices about people who are different from them. This model also suggests that adoption professionals help the families share their views and set clear expectations for contact and communication. “The success of open adoption depends on clear boundaries [and] the participants’ respect for each other’s roles and responsibilities” (Pavao, 1998, p. 130).
Support groups are also a significant part of this model because they assist families in expanding their concept of kinship. These groups include members of foster and adoptive families that are parenting special-needs children as well as groups with members of adoptive and birth families who maintain open relationships. These support groups provide families with a model of successful open relationships and give people an opportunity to express their fears and learn from others.
Effective Pre- and Post-adoption Services
Understanding what adoptive families with special-needs children want can be invaluable when planning appropriate and effective pre- and postadoption programs. Barth and Miller (2000) outline the types of services that adoptive parents seek most often. These parents are looking for educational and informational services that involve topics such as financial costs and special services. They also want clinical services which involve counseling (individual, marital, and family), respite care, and crisis counseling. A final category includes material services such as subsidies and health benefits. McKenzie (1993) also emphasizes financial assistance as an area of focus for postadoption services. Adoptive parents of children with special needs also evaluated support groups and contact with other adoptive parents as very helpful (Rosenthal, 1993). Kramer and Houston (1999) also found that mutual support from other adoptive families and mentoring programs were effective in meeting the needs of adoptive parents. Gray (2002) recommends forming a team of supportive friends and family members in addition to seeking professional help to prevent isolation, obtain help with certain tasks, and enhance the overall system of support. The following case demonstrates the success of support groups and mentoring programs.
Some parents report barriers to obtaining postadoptive services (Reilly & Platz, 2003). The barriers included not knowing where to go for services and a perception that those who were there to help did not comprehend their problems. Parents with children above the age of 14 reported the most difficulty obtaining services. This information is critical for adoption agency programs, because it indicates the agencies must continue to reach out to the adoptive families and provide accessible support after the adoption. It also indicates a need for appropriate training of agency staff so that they can empathize with the unique challenges that can face families who adopt special-needs children. “Specialized training in the competencies needed by foster care and adoption supervisors and workers should have high priority” (McKenzie, 1993, p. 75). Reilly and Platz (2003) also found that the longer the child was in the home, the more the behavior problems that were reported. This highlights the importance of extensive and ongoing postadoption services, because it is possible that behavior problems may not surface until the child has been in the home for some time.
Brief Clinical Case
Mr. and Mrs. Jones, the parents of an 8-year-old girl, applied to the local child welfare authority to become foster parents with the long-term goal of adopting two children. A sibling pair, ages 4 and 6, was placed in their care shortly after they finished the home study process. The foster children, Peter and Warren, had been abused and neglected and removed from their birth family 2 weeks before. After a short stay in a temporary foster home, they were placed with the Jones family. From the beginning, it was clear that Peter and Warren had lived in a very chaotic household. They were not used to sitting at the table for dinner, going to bed at a regular time, or complying with the Jones family routines. After a month, Mr. and Mrs. Jones told their caseworker the placement wasn’t working out. Their daughter was beginning to misbehave and to resent the behavior of her foster brothers. Mrs. Jones was called to the school because of the boys’ behavior. The caseworker recommended that Mr. and Mrs. Jones join an adoptive parent support group, and she arranged for them to have a buddy mentor (ongoing contact with an experienced foster family). Mr. and Mrs. Jones were offered respite care for the boys one weekend per month. They spent extra time then with their daughter, who was feeling very neglected due to the extreme demands of the boys. Over time, the boys settled down and Mr. and Mrs. Jones began to enjoy them more.
Best Practices
It is evident from this chapter that professionals in the field of adoption must be educated in the unique challenges present in special-needs adoptions. Agencies should provide adequate training programs for their employees that include information on the challenges faced by special-needs adoptees and their families such as attachment difficulties, behavioral issues, and stressors. They should also be knowledgeable about the ways to effectively deal with these challenges, such as providing individual counseling, respite care, and support groups so that they are prepared to help families adjust and thrive. Families should have adequate access to all pre- and postadoption services through the agency or be referred to an appropriate resource that can provide the help they require.
Conclusion
Families who adopt children with special needs have unique challenges related to attachment difficulties and increased levels of stress. Agencies must be aware of this and provide adequate preparation and information about the child so that parents develop appropriate expectations. This will result in less disruption and more positive outcomes. Postadoption services should be easily accessible and provide education, information, and counseling for all members of the family and connect families to support groups so that they can share with others who understand their experiences. This will ensure that the needs of all members of the family are met and that the adoption experience is a positive and satisfying one for all involved.
Reflection Questions
- Why is it important for adoption professionals to learn why a family is interested in adopting a special-needs child and their expectations about life with that child?
- What are the potential benefits or risks (short- and long-term) associated with an open special-needs adoption for the adoptee, birth family, and adoptive family?