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Adoption - What Special Needs Are You Willing to Accept?

How to make an informed decision in your adoption application and referral. What special need, medical or health condition are you open to in your adoption?

By Patricia Irwin Johnston, author of Adopting: Sound Choices, Strong Families

Health is a relative thing. What represents compromise to you? Where is the line over which you just can't go?

First, be realistic. It is utterly, completely, totally impossible for an agency, intermediary, or birthparent to guarantee you a completely healthy child. Children who are born apparently healthy and whose gene pools do not indicate the likelihood of impairments regularly develop illnesses and conditions that could not be predicted. This happens in families of the sturdiest stock and to mothers with the best of prenatal care, and it could just as likely have happened to you, had you given birth. There are no guarantees in parenting. Your ability to be as flexible as possible in this area will significantly increase your odds of becoming a parent sooner and to a younger child.

Agencies will definitely ask you to carefully consider your limitations regarding the predictable health and abilities of a child. Most are likely to provide you with a checklist filled with the names of illnesses and disabilities, and ask you to check off yes, no, or maybe. What they will not likely do is offer you any specific information about the problems on those lists. Here's more homework for you.

Of course you can Google a lot of this, and that will give you helpful definitions and explanations, but it won't give you firsthand experience from parents who have been there and done that. Once again consider NACAC and a referral to local adoptive parent groups as your first line resource. In addition to grassroots adoptive parent support groups (APSGs) every state has an organization of foster and adoptive parents supported by federal funds. It may have a name like Indiana's, which is IFCAA-the Indiana Foster Care and Adoption Association, or like Connecticut's, which is CAFAP-Connecticut Association of Foster and Adoptive Parents. These groups have small paid staffs and multiple goals. They are part of the recruitment and support system for those who foster children for the state, offering them respite care, providing continuing education opportunities for the maintenance of their licensure as foster parents, and providing peer support. They also serve the foster parents who eventually adopt the children in their care and those who adopt outright from the public welfare system. This group in your state is an invaluable source of information and referral.

Also contact your local United Way or other community clearinghouse and ask for referrals to agencies and support groups dealing with the health problems which you would like to learn more about. Talk directly to parents dealing with these problems. In doing so you will discover that the vast majority of things on those lists are problems that can range in severity from quite minor to overwhelmingly disabling. And, some things that could appear on the surface to be fully correctable or purely cosmetic can be symptomatic of far more serious conditions.

My advice is this: the more maybes you can check, the better. If your answers are mostly no's you're going to be called only when pure perfection is available. If your answers are yes or maybe, you'll probably be on the short list for a lot of possibilities. Remember, you can always say no to a specific situation that just feels wrong. This is something over which you do have absolute control. (No, it won't necessarily be easy to allow yourself to do this.) You can always take the time to fully investigate the health issues presented to you before saying yes or no to the adoption. On the other hand, you can't say yes to something you don't even know about.

If possible, establish rapport with the physician who will be your child's pediatrician before your child arrives. Choosing a pediatrician who is knowledgeable about adoption issues can be important for any family. It may become even more important if you are adopting a child with emotional problems or a child from another country who may be at risk for infectious diseases less commonly seen in this country. Speak with other adoptive parents about their pediatricians. Look for the possibility in your community of an adoption medicine clinic (often a part of a teaching hospital, but sometimes a private practice choice for a pediatrician-especially one who is herself an adoptive or foster parent). Ask whether this doctor would be willing to review health and birth records and offer a medical opinion before you accept a referral either internationally or domestically. If you are adopting a newborn, sometimes your doctor will be willing and able to check the baby out in the hospital. If your adoption comes so suddenly that you have not able to engage a pediatrician before your child's arrival, ask your own primary care physician if he or she would be willing either to examine these records or to refer you to specialized help if needed.


Pat Johnston is a well regarded publisher, prolific author, and adoption advocate. This article is excerpted from her book, Adopting: Sound Choices, Strong Families, a thoughtful guide to all aspects of adoption. Chapter 9 "Which Child?" (Perspectives Press, 2008)

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