Things to considering before the adoption of a special needs or drug/alcohol-exposed child

A prospective adoptive parent (PAP) who is considering adopting a child exposed to drugs and alcohol recently asked me what advice I could give her. She wanted to know what she should be doing to prepare herself. I was impressed that she was asking, since so many people just jump into adoption like this. I ended up writing a novel as a response, and ultimately decided that I should share it here, too. What I outlined really applies to “special needs” children and/or children who have been exposed to drugs or alcohol in the womb.

First, it is so hard to give others advice in this area, because there are so many variables. A child who has been indicated as “special needs” in international, domestic, or foster adoption may have a minor correctable condition. The condition may require surgery, or it may just go away on its own. On the other hand, the medical history can be incomplete, and the special need indicated in a child’s file may just be the tip of the iceberg. For example, a child with cleft palate or cleft lip may be listed as having a “minor” special need. Some adoption agencies may tell a PAP that the condition will require a simple surgery, and then everything will be fine. While it’s true that this is possible, it is also possible that a surgery will not be successful and will need to be repeated. It is possible that the child will have additional speech and nutrition issues that will need to be addressed by other therapists or specialists. It is also possible that the cleft lip or palate may be related to a genetic condition that affects the child in other areas. PAPs need to be prepared to bring home a child that may require more care than they were initially told.

There are also huge variables when it comes to drug and/or alcohol exposure. Our son was born positive for cocaine. We were told that the cocaine use was limited and that his birthmom only drank once because it made her sick. This was not true. He was diagnosed with Fetal Alcohol Syndrome before he was two. We naively thought that he would be OK because cocaine leaves the body so quickly. We had been told over and over that we would be better off adopting a baby who had been exposed to cocaine than one who had been exposed to alcohol. What we were not told is that drugs usually go hand-in-hand with other drugs and with alcohol.

Our son’s birthmom was not honest about her use. I think she was scared, embarrassed, etc. Also, I think she thought she was doing the right thing by admitting to the “worst” substance, which in her mind was cocaine. She honestly did not know that alcohol was worse for her baby. We blame our attorney in this, too. While we realize Colin’s birthmom may not have been honest with the attorney, he didn’t bother to ask her at the time of Colin’s birth if the information she had given him five to six months earlier was still accurate. He had no contact with her during the rest of the pregnancy. He didn’t check on her at all.

I would NEVER go back and undo Colin’s adoption. I love him with all of my heart. However, I certainly wish we had been more prepared. This is the advice I would give to PAPs considering adopting a special needs or drug and/or alcohol exposed child:

  1. Be REALLY honest with yourself about what you are willing to handle. If you only want to adopt a special needs child or a child who has been exposed to drugs or alcohol because it means your adoption will probably proceed more quickly, you should reconsider. (Yes, unfortunately, there are many PAPs who do this.) This is a lifetime commitment.
  2. Assess what you are really capable of handling. Do you have financial resources? Do you work outside the home? Could you stay home if you needed to? Just the logistics of managing medical appointments can be really stressful. Would you have time to take your child to occupational therapy, physical therapy, specialists, etc? Are you healthy enough yourself, mentally and physically, to deal with possible challenges or worst-case scenarios?
  3. Make sure you have the most up-to-date information. If you are adopting internationally, find out when the last medical exam was done on the child. Find out if there is any available information on previous medical exams. Find out what kind of care the child is receiving in country. If you are adopting an infant domestically, find out when the agency or attorney last had contact with the expectant mother. How frequently do they have contact? When was the last time she saw a doctor? How regularly does she see a doctor? When did she start receiving prenatal care? Have there been any complications with the pregnancy? If you are adopting from foster care, when was the child’s last medical exam? Are there any gaps in the child’s medical history?
  4. In international adoption, many people meet with a doctor who specializes in international adoption or a developmental pediatrician to discuss possible health conditions. Then when they receive a referral, they share that info with the doctor and get an opinion before deciding whether or not to accept the referral. This does not seem as common in domestic adoption, but I would suggest doing something similar. Get recommendations for a good developmental pediatrician in your area. Once you have a match, take the expectant mom’s file to the doctor to discuss it.
  5. Does your homestudy agency or social worker really understand these kinds of adoptions? Can they talk to you about possible health outcomes of children with specific special needs or a child exposed to different substances? If not, can they put you in touch with someone who can? Can you find other parents of children who have similar health circumstances who can answer questions for you now and be a support system for you later?
  6. Learn about your state’s early intervention program. They are called things like First Steps or Babies Can’t Wait. They are programs specifically designed to help children 0-3 who have developmental challenges. Learn about the other resources available in your area. Get referrals for the types of specialists your child might need.
  7. Look into your state’s Medicaid coverage, disability waivers, etc. Does your child qualify? Do you need to apply BEFORE you finalize the adoption?
  8. Look at your insurance policy. Know your deductible and family out-of-pocket amounts, and be prepared to spend that entire amount when your child first comes home, just in case.

I know there are other adoptive parents of children with special needs reading this blog. Do you have any other suggestions? Are there other things I should add to this list?

7 thoughts on “Things to considering before the adoption of a special needs or drug/alcohol-exposed child

  1. I think this is good advice for anyone considering adoption in general. Our “healthy, as young as possible, baby girl” is now diagnosed with moderate autism, an unrelated significant learning disability, and is being tested for brain damage due to lack of short term memory ability and the above mentioned learning disability. We have no “why’s” or no family history. We don’t know if this is genetic or if there is a cause none of us can figure out because there is no genetic link to check.

    Then again, my biological child has autism too. So I guess you never know…

    I know the China special needs program is very popular and people are already planning to switch to a new Vietnam special needs program. It scares me because very few people know really what they are getting into–a lot of people in the adoption world consider “cleft lip, cleft palate” to be a minor condition in the China adoption world and people compete for those referrals–forget the fact that it will require several major surgeries, years of speech therapy, and possible issues with the heart and other midline issues.

  2. I totally agree with the fact that “non special needs” kids many times have undisclosed special needs that you don’t find out about until you are home. Sunshine’s medical issues though are now managed and she is doing well but it was very difficult and rough in the beginning. She had 2 surgeries in her first year home.

    Emotionally having a child with any “special need” is harder than you can imagine. Make very sure you have help and loads and support so that you can take a break when you need to and you have whatever medical and developmental professionals available so that your child can receive any and all help he/she needs to thrive.

  3. You are both absolutely right. As with a biological child, there are no guarantees that a child who is adopted will be healthly. Plus, you may not have any family history and information about genetic conditions. Additionally, if a child has been in an orphanage or in foster care, there could be neglect, nutrition, emotional, attachment issues, etc. If the child is adopted domestically as an infant, there are no guarantees that the birth mom had adequate prenatal care.

  4. This is a great list Tracy!
    I like number 4, I still have files full of the birth mom’s and S’s medical records…and I have no idea what all they say. I should really have a doctor explain this to me -better late than never!

  5. I would add something about getting some things set up BEFORE you come home to help when you do. Assume the worst. Find a therapist, a behaviorist, medical specialists and make the appointments before you go. Use the therapist even if you don’t think you need it.

    Line up friends and family to find a way to give you a break within the context of bonding with your child. No matter what his or her needs are, transitions aren’t easy. Common Wisdom is that you have to be there all that time to gain trust and attachment–but you, fraught and tense and overwhelmed, doesn’t help. Plan to trade times with your partner. Plan to get out with friends by adding one more trusted caregiver to your rotation if you can. Find a way to give kids who are already in the house time, too. A school setting may not seem like a good idea, but you might want to find one and set things up–lots of kids had a school setting of some kind before and another can be comforting and not feel like somewhere the child is supposed to attach or another caregiver.

    Plan to be overwhelmed, and if you’re not, bask!

    • Very good points, KJ. Attachment is important, but you’re probably not doing much bonding if you are frazzled and exhausted. It is absolutely important to have a break every now and then, and to have people in your support system you can call before you reach your breaking point.

  6. What a great post Tracy!

    I loved your cleft palate example – it’s so much more than a few surgeries…good insurance is a must and early intervention is key. I spend a lot of time in appointments with a wide range of specialists.

    I also loved a book by Patty Cogen called “Parenting your Internationally Adopted Child” such great information on biological and physiological development.

    Great suggestions!

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