A. Preadoption. If involved during the preadoption process, a clinician should attempt to obtain information from birth parents and medical records via the adoption agency. Children with a history of adoption are somewhat more likely than the general population to later be diagnosed with attention deficit hyperactivity disorder, fetal alcohol spectrum disorder, intellectual disability, or have congenital malformations. The clinician should specifically ask about known family history and consider the relevance for the adoptive parents and their child. The clinician should also try to obtain details about the birth parents’ appearance, interests and talents, education and work, and their reason for placing the child for adoption; information that an adopted child may be interested in learning later in life.

B. Postadoption. Studies indicate that adoptive families may struggle with transitional problems but that adequate preadoptive preparation can decrease this risk. All parents may have idealized expectations about their child’s behaviors that may not be realized, and adoptive parents may additionally be dealing with the loss of their fantasized birth child. As a result, a clinician should plan a follow-up visit sooner after a newly adopted child joins their family rather than later, and keep close and frequent contact with the adoptive parents in order to understand parental expectations and child behavior. Especially after international adoption, children should be screened for a range of possible infections as well as having routine vision, hearing, and developmental/behavioral surveillance.

C. Older child adoption. For children adopted beyond the newborn period, the clinician should seek additional information on the history and quality of the child’s social attachments, history of adverse experiences (such as abuse, deprivation, neglect, rejections, and separations), and educational experience (including quantity, quality, and potential special needs).

A. When to tell the child he is adopted. Most experts suggest that families begin discussing adoptive and birth history as soon as a child joins their family. For newborns, this allows parents to become comfortable discussing the topic of adoption without worrying about a child’s response. It is imperative that all children learn the important points of their adoptive history from their adoptive parents rather than from someone else. For children adopted in toddlerhood and beyond, memories of their preadoptive experiences will need to be integrated with their story of adoption. Many adoptive children find creating a “life book” which details their history prior to and following joining their adoptive family to be a positive experience.

B. How to tell the child he is adopted. A discussion of a child’s “history of adoption” can be expected to happen many times over the years rather than in a single “disclosure conversation.” A child’s adoption story should be explained at an appropriate developmental level and with enough, but not too much, information. The following elements are helpful to convey to a child or adolescence about being adopted during conversation:

C. Sequence of developmental issues. A child’s understanding of adoption changes as he develops. At different ages, children will focus on different issues and need access to different information (Table 89-1).