Encyclopedia of Adoption

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The Encyclopedia of Adoption

The Encyclopedia of Adoption Foreword

Adoption is a constantly evolving institution
that changes to fit the perceived needs of children
who need families, whether they are healthy
newborns, children in foster care, children from
other countries, or children of all ages with special
needs. In addition to the “triad” members of
adopted children, adoptive parents, and birthparents,
there are many others who are actively
involved in adoptions. State and federal legislators
enact new laws or rewrite old laws to fulfill new
needs or to manage newly recognized problems.
Sometimes new laws are made in order to correct
unanticipated problems that old laws created, as
with the Adoption and Safe Families Act (ASFA).
This federal law was written because the earlier
federal law, the Adoption Assistance and Child
Welfare Act of 1980, had the unanticipated consequence
of keeping abused and neglected children
in foster care indefinitely rather than returning
them to their parents or placing them for adoption
with relatives or nonrelatives. ASFA restored the
needs of children as the paramount concern, as we
discuss in the entry on ASFA.

States also change their adoption laws to reflect
current needs of adults; for example, many states
have changed their laws on issues related to
adopted adults who are searching for their birthparents,
providing increased access to adoption
records compared to past years. We discuss these
changes in our search overview.
Medical issues related to adoption also change
with time. Physicians, particularly pediatricians,
assist children and their adoptive parents with a
variety of medical issues. With increasing numbers
of international adoptions, more doctors are
becoming aware of medical problems that do not
commonly occur in the United States or Canada
but which are common in children adopted from
other countries, such as intestinal parasitic infections
and tuberculosis, entries that we cover in this
new edition. In fact, a new specialty, adoption
medicine, has been created to deal with such problems,
and we have added an entry on adoption
medicine to the third edition.

Researchers seek to study and uncover the reasons
behind medical and psychiatric issues related
to adoption. However, they are often hamstrung by
issues of confidentiality and the great expense of
large and long-term studies and, as a result, must
frequently consider a population at a single point in
time, which may not reflect the ongoing status of
study subjects. For example, adopted children who
are evaluated as adolescents might show very different
results if they were evaluated again by
researchers as adults. Birthmothers who may be
depressed or anxious about a recent adoptive
placement are not necessarily clinically depressed
or anxious for life (although they may be). As a
result, research studies need to be considered in
context and we discuss this issue further in our
new entry on research and problems that need to
be considered, as well as in our revised entry on
adoption studies.

Social workers and therapists work to assist children
who have been affected by past problems of
abuse or with current issues with which they struggle.
However, sometimes because of old and outdated
information, mental health professionals It is important to point out that many adoption
topics are closely linked, and as a result, we have
provided extensive cross-references with many
entries to assist readers seeking more information.
For example, the subject of abuse is linked to foster
care, since many abused children enter the foster
care system. The topic of abuse itself is also linked
to entries on such topics as abandonment, neglect,
and sexual abuse.
In the case of international adoption, we have
cross-referenced our overview entry on this topic to
other entries on adoption from China, Guatemala,
India, Russia, South Korea, Latin American adoptions,
and eastern European adoptions, as well as
to our overview entry on the medical problems of
internationally adopted children.
Readers interested in the adoption of children by
their relatives will wish to read our revised overview
entry on kinship care as well as other revised
entries, such as on grandparent adoption.
Individuals who have adopted or are interested in
adopting a child may wish to read our revised entries
on adoptive parents, birthfathers, and birthmothers,
as well as our updated entries on the so-called baby
shortage, costs to adopt, employment benefits, hospitals’
treatment of birthmothers, income tax benefits
for adoptive parents, independent adoption,
infant adoption, open adoption and transracial
adoption. Readers interested in genetic issues will
wish to read our completely revised entry on genetic
predispositions, as well as our revised entry on intelligence.
Readers who are interested in other options
to expand a family besides adoption will wish to read
our entries on assisted reproductive technologies,
infertility, and surrogacy arrangements.

To conclude, the institution of adoption will
continue to shift and change to meet the needs of
children, while reflecting social and cultural practices
and beliefs. One thing does not change, however,
and that is that children throughout the
world will need parents. We hope that many people
will step up to this rewarding task.

We also hope that the extensive information
that we provide in this volume will give readers
insight to how adoption works in the lives of many
people who are affected by it, and they will find
this volume to be useful and thought-provoking.


Adoption is a life-changing experience for the
key participants, including the adopted child,
the birthparents, and the adoptive parents. There
are also many others who are affected less directly,
such as siblings, grandparents, and other relatives,
as well as professionals, including teachers and
physicians. Nearly everyone knows someone who
was adopted, who adopted a child, or who placed a
child for adoption, or “all of the above” -although
sometimes this information is withheld from others.
There is both pain and joy with adoption. The
birthparent suffers the pain of the loss of the biological
child, while infertile individuals must cope
with the pain of the unrealized dream of a biological
child. Adopted children must face their loss,
which is that the families who are raising them are
not the families of their birth. Even in the case
when the adoptive parents are clearly wonderful
parents and the birthparents would equally clearly
have provided very poor parenting to the child,
there is still often a feeling of loss and “what if”
among adopted children. If all children could be
reared by their biological parents, adoption would
be unnecessary, but it is unlikely that day will
come. If it did, I personally would rejoice, since the
main purpose of adoption is to provide good families
for children who need them.
There is also joy in adoption, which continues to
bring hope and love to many thousands of children
and their families worldwide. Rather than condemning
children to a life with birthparents who
are unable or unwilling to care for them, children
can instead be raised by individuals who are ready
and eager to be parents. The birthparents can feel
assured that their children are with parents who
love and care for them, and for the adoptive parents,
the child is a precious joy.
Sometimes birthparents willingly choose adoption
for their children, and in other cases, the
choice is made for them by others, whether the
dysfunction that led them to be abusive or neglectful
parents is due to alcoholism, drug addiction,
mental illness or other problems, or a combination
of problems. New families are then formed when
former foster children join their families as legally
adopted children. Some children travel thousands
of miles to live with their “forever families,”
adopted from orphanages and foster care in other
countries. International adoption has become an
increasingly important part of adoption as a whole.
Yet there is still often a great deal of confusion
about whether adoptive families are “as good as”
biological families, which was probably a key impetus
behind the past policy of returning foster children
to abusive homes, again and again. (The
Adoption and Safe Families Act has improved that
situation considerably.)

In addition, most research studies concentrate
on pathology, such as alcoholism, drug abuse, psychiatric
problems, and so forth. Few studies seek to
identify what is healthy about adoptive children
and their families, and some researchers seem
amazed that so many adoptive families and
adopted children function even moderately well.
This should not be a surprising finding, however,
given that most adoptive parents intensely
desired to adopt their children, were usually thoroughly them, and actively seek to be good parents. Sometimes
they try too hard and worry too much, and
some adoptive parents take their children to a therapist
for minor emotional problems. Of course, a
good therapist will advise parents when the problem
is a normal childhood issue.
At the same time, sometimes adopted children
do have serious emotional problems, and denying
that they exist, and hoping that they will magically
go away, is a harmful strategy for the child. It can
be difficult, although it is possible, to find a therapist
who acknowledges that the fact of adoption
may cause pain to adopted children, while at the
same time the therapist realizes adoption itself is
not the sole explanation for every emotional disorder
of a person who happens to be adopted. We
explore these issues in the entries of The Encyclopedia
of Adoption, Third Edition.
It is also important to consider how adopted
children might have developed had they not been
adopted: if the sexually abused six-year-old girl
remained with her abusive family, what would
have been her likely outcome? Or what of the single
mother who desires to make an adoption plan
and she is talked out of it-or the single mother
who wishes to parent her child and is talked into an
unwanted adoption? What would be the outcomes
in these alternative cases? Such events profoundly
affect and shape the lives of the birthmother and
the child and, when the child is adopted, the adopting
parents, as well.
To a certain extent, there are some answers. It is
known that children who remain with abusive parents
have a worse outcome than children who are
adopted. It is known that children who remain in
foster care for years and who “age out” of the system
as adults usually have worse outcomes than
children adopted as infants or small children.
Yet most studies do not compare the outcome of
adopted children to the likely outcome had they
not been adopted, largely because such studies are
difficult to perform because of confidentiality.
Instead, researchers often compare adopted children
directly to nonadopted children, who have
not been exposed prenatally to toxic substances,
have not lived in deprived circumstances, have not
been beaten or starved, and instead who came
directly home from the hospital with Mom and
Dad. As a result, it is not surprising that sometimes
adopted children do not fare as well as children
born to the family, in many different measures.
Instead, what is surprising is that so often, adopted
and nonadopted children are very close in terms of
positive outcomes.
When adopted children have serious problems,
it is often the events that preceded the adoption
which are the primary contributors to the child’s
problems, whether they are prenatal exposures to
alcohol and illegal drugs, genetic predispositions to
psychiatric problems, the experience of abuse
and/or neglect, and other factors that may have
profound effects on children. Yet, despite even the
most severe neglect or abuse, some children are
resilient, and being adopted is one means to allow
them to transcend these problems.
This does not mean that adoptive parents themselves
are without flaws. Sometimes adoptive parents
know far too little about adoption in general
or about the particular child they wish to adopt,
even when information is readily available. They
may assume that love will conquer all problems,
which is not a good working premise. They may
change the name of an older child and urge her to
forget everything that happened to her before
today, assuming that she can or should.
There are many mistakes that adoptive parents
can and do make; however, from my observations
based on studying adoption for nearly 20 years and
speaking to hundreds of adoptive parents, most do
their best, and when they have problems, they seek
help from others who are more experienced,
including other adoptive parents, physicians, and
However, it should also be mentioned that perhaps
once a year, the media report on an adoptive
parent who has abused or even killed a child. These
rare and shocking circumstances happen and they
are real, but the overwhelming majority of adoptive
parents are loving and caring people.

A major problem is that more adoptive parents
are needed. Hundreds of thousands of children in
foster care and in orphanages worldwide need
adoptive families now. They do not know or care
about rules and regulations or why they must stay
in an orphanage or in a series of foster homes. They
only know they want a family to love them. Yet in
screened before they were allowed to adopt some cases, they do not know they need a family to
care for them, in the same way that a child who is
nearsighted does not know she needs glasses until
glasses are placed in front of her, and suddenly
everything is acutely clear.
Similarly, some older children have never
known the love of a family, and it is an alien concept.
When they experience it, however, the transformation
to the life of the child can be truly
amazing. No one attains a perfect life with adoption,
but the changes in opportunities and emotional
fulfillment can be staggering.
In this book, Dr. Miller and I have attempted
to seek out as much of the current research we
could identify that might be salient and interesting
to readers who want to know more about
adoption, whether they seek information on one
specific topic or are intrigued by many different
topics related to adoption. We have included
many new medical topics, such as new entries on
attachment disorders, hepatitis, prenatal exposures,
rickets, and many other topics that readers
may find useful.
We could not hope to include every study and
every possible aspect of adoption within one volume,
but we have provided an extensive breadth of
subjects as well as a detailed bibliography for those
who wish to learn even more. The Encyclopedia of
Adoption also provides appendixes with listings of
organizations related to adoption, including private
and governmental organizations.
This book is meant for the general reader, and
we hope that it will also interest the adoption
expert. As a result, jargon has been kept to a minimum,
or, when the use of jargon has been necessary,
clear explanations on what these terms mean
and what they imply are provided.

We hope this new edition of The Encyclopedia of
Adoption will not only enlighten readers but may
also inspire them to look further into this subject,
even to launch a study or investigation on some
aspect of adoption that needs further exploration.

In my view, adoption is a very complicated, imperfect,
and yet wonderful institution. Learning about
adoption further advances the knowledge and
understanding among those who are directly
affected by adoption-adopted individuals, birthparents,
and adoptive parents-as well as those
within our society who set the standards for adoption
and the federal and state lawmakers who
make the rules that we live by. The children are
worth every effort that we all can make. They are
our future.
-Christine Adamec

Preface 2

Biology dictates that all children need loving
and attentive adult care in order to thrive. Yet
untold numbers of children throughout the world
cannot be cared for by their parents. Poverty,
immaturity, lack of emotional resources, substance
abuse, mental or physical illness, and death
may all prevent parents from caring for their children.
In recent decades, death from infection with
the human immunodeficiency virus (HIV) has
plagued millions of families globally, leaving more
than 15 million children without parents. Some
children without families live on the streets in
cities throughout the world, others are trafficked
as prostitutes or virtual slaves, while still others
are consigned to orphanages or other institutions.
In America, more than 500,000 children who
cannot be cared for by their parents reside in foster
care, too many of them moving from one
home to another throughout their childhoods.
Some of these children are adopted, while tens of
thousands urgently need families.
Adoption is the legal means by which a child
permanently joins a family. An astonishing one in
five Americans is directly touched by adoption,
according to a survey conducted by the Evan B.
Donaldson Institute in 1997. Our friends, coworkers,
relatives, and close family members are themselves
adopted or are connected to adoption in
some other way. They may be birthparents, birth
siblings, birth grandparents, or other relatives.
They may be adoptive parents, grandparents,
aunts, uncles, cousins, siblings, friends, and neighbors.
In recognition of the far-reaching nature of
adoption, Adam Pertman aptly subtitled his recent
book Adoption Nation “How the Adoption Revolution
is Transforming America.”
Although the Donaldson survey found that 90
percent of Americans viewed adoption positively and
95 percent agreed it serves a useful purpose, some
responses were not so favorable. Half of the respondents
stated that adoption is not quite as good as having
one’s own child, 25 percent said it is sometimes
harder to love an adopted child, and nearly 33 percent
doubted that children could love adoptive parents
as much as they could love birthparents.
This attitude reflects our Western cultural bias
about adoption. In other parts of the world, for
example, the Pacific Islands, adoption is considered
a particularly revered form of family. In Tahiti,
25-40 percent of all children are adopted, and families
hope, as quoted by author Elizabeth Bartholet,
“to establish between parents and natural children
relationships which coincide as nearly as possible
with those between parents and adopted children.”
However, in other nations, misconceptions
about adoption abound. In some countries, adoption
is considered a shameful secret, or an act to be
spurned. Occasionally, popular opinion becomes
aroused when sensational, shocking, and false stories
appear that children are adopted by rich Westerners
to be used as servants.
In the United States and other countries, adoption
practice has been tainted at times by charges of
baby-selling, “false advertising,” and massively
inflated costs. Clearly, for the benefit of children in
need of families, and all parties involved, adoption
practice wherever it occurs must be held to the
highest ethical standards.

Regardless of difficulties, adoption goes on, driven
by the desire of adoptive parents for children to
love and by the recognition of the need of children
for families. Parents choose to adopt for many reasons-
best summarized by the Persian poet Kahlil
Gibran: “Your children are not your children-they
are the sons and daughters of life’s longing for
itself.” Adoptive parents can be married or single,
heterosexual, gay, or lesbian, young or old, fertile
or infertile, first-time or experienced parents. They
share a willingness to jump through endless hoops
to get a child-sometimes even involving laws of
other countries, exotic diseases, and travel to unfamiliar
places. The desire to adopt does not discriminate-
it can strike almost any adult, and one
adoption may not be enough to satisfy the urge!
All child development experts agree that children
need families. Experiments conducted by
Harry Harlow and others demonstrate convincingly
that young primates need responsive parenting in
order to grow and thrive. For children whose own
families cannot care for them, adoption provides a
positive alternative, allowing many children to
grow up healthy, happy, and loved.
Surprisingly, there are few definitive statistics
about domestic adoption. However, statistics are
readily available about international adoption
through the Department of State. International
adoption has increased dramatically in the past 10
years, from 8,195 in 1994 to 22,728 children in
Many of these adoptions are “visible,” that is,
children who are placed with ethnically and racially
different parents. The rise in these visible placements
has greatly increased awareness about adoption.
Indeed, Pertman writes, “Across the United
States today, it is getting increasingly difficult to
find a playground without at least one little girl
from China, being watched lovingly by a white
mother or father.” In some parts of the country,
every school, every grade, and every classroom has
internationally adopted children. Indeed, an adoptive
father recently told me of his delight when the
anticipated difficulties of a search for an “adoptionfriendly”
day care for his Russian-born son quickly
vanished. In the first day-care center he visited,
there were three international adoptees out of the
five children in his son’s age group.
The most common countries of origin for international
adoptees have been China, Russia,
Guatemala, Korea, and Ukraine, which together
account for 82 percent of the 167,174 children
placed with American parents in the past 10 years.
Parents in other nations, including Canada, Spain,
England, Italy, France, Australia, New Zealand, and
Scandinavian countries also adopt children from
Until recently, adopted children and families
have been ignored by physicians, except for those
with research interests in the field, or those whose
clinical practices brought them into proximity with
many adopted individuals. Over the past several
years, a burgeoning interest in adopted children
has arisen among pediatricians, triggered in part by
the visibility and urgent medical issues of the
increasing number of internationally adopted children
arriving in the United States.
Some of these issues are related to medical problems
specific to the country of origin, including
“exotic” infectious diseases such as malaria or
intestinal parasites. However, more commonly, the
issues reflect the suboptimal care of the children in
early life, including prenatal exposures (drugs and
alcohol), malnutrition, micronutrient deficiencies,
toxic environmental exposures (lead), and most
importantly, emotional and physical neglect.
Recognition of these problems in international
adoptees has also increased the awareness of the
medical needs of American children residing in
foster care-a group with specialized health-care
issues which for too long has been sadly neglected
for the most part by the medical community. Pediatricians
are recognizing the need for these children
to have a “medical home” during their time in
foster care and the need for continuity of care for
those who are later adopted. In 2000 the American
Academy of Pediatrics formally recognized a Section
of Adoption and Foster Care, a group of pediatricians
interested in promoting the care of foster
and adopted children.
This long overdue step places adopted and foster
children on the national pediatric agenda for
health policies. Among the many issues confronting
the Section are the development of appropriate
diagnostic codes for necessary medical care
of foster and adopted children (necessary for insurance, billing, and reimbursement), support of legislation
(such as the Adoption and Safe Families Act,
or ASFA), which expedites adoptions, improved
coordination of care and medical record keeping
for foster children, compliance with medical provisions
contained within the Hague Convention on
Intercountry Adoption, promotion of high-quality
research on health and developmental issues for
adoptees, and many other activities devoted to
serving the best interests of these children.
Research on adoption has expanded as awareness
of the special issues of this population has
become more widespread. For many years,
researchers took advantage of adoption as a natural
“experiment” to test hypotheses about nature and
nurture. Such investigations yielded valuable
information about genetic and environmental contributions
to behavior, health, and mental and
physical disorders. Although this important work
continues, in recent years the focus of adoption
research has expanded to address the health and
well-being of adoptive children and families, and
the factors which promote favorable outcomes.
Research by Joyce Maguire Pavao and others has
improved understanding of “normative crises” in
adoptive families, shedding light on normal,
expected stages of adjustment for children and parents.
Such research is directly applicable to the lives
of adopted children and families and may aid professionals
who deal with these individuals in their
daily practice.

This book provides an overview of many of the
issues faced by adoptive families, adopted children,
birthparents, foster children, and adoption
professionals. It contains valuable information
for high school and college students as well as
professionals-teachers, therapists, physicians-
who encounter people touched by adoption in
their work. Christine Adamec and I have assembled
a compendium of detailed information, references,
and resources. This book will be a useful
guide to those with long and close familiarity
with adoption, or to anyone new to this fascinating
and wonderful world.

It is worth noting that the United Nations Declaration
on the Rights of the Child addresses the
needs of children without parental care. The
United States is the only UN member state to have
signed this document but not ratified it, as of June
2005. (UN member Somalia has neither signed nor
ratified the convention.) The Declaration asserts
that all children are entitled to “grow up in a family
environment, in an atmosphere of happiness,
love and understanding.” Sadly, this goal is a long
way from being achieved. Untold thousands of
children reside in institutional care throughout the
world. In many countries, domestic adoption programs
are virtually nonexistent.

In our own country, too many children languish
in foster care and despite changes to laws to facilitate
their adoption, large numbers are caught in
“legal limbo” which while admirably attempting to
preserve the rights of their birthparents does so at
the expense of freeing the child for adoption. Some
would-be adoptive parents are dissuaded from pursuing
adoption due to perceived legal complexities
and the fear of the birthmother “changing her
mind” -a statistically unlikely event, despite the
noisy publicity about the few episodes that do
occur. Although progress has been made in facilitating,
supporting, and expediting adoption, much
more remains to be done. All must remember the
urgency of the mission to provide loving and permanent
homes for all children in need.”

Laurie C. Miller, M.D.

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