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:
- 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.
- 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?
- 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?
- 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.
- 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?
- 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.
- Look into your state’s Medicaid coverage, disability waivers, etc. Does your child qualify? Do you need to apply BEFORE you finalize the adoption?
- 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?