Adoption of Children with Special Needs

Important Considerations

There are over 100,000 children in foster care waiting to be adopted. Many of the children who wait the longest to become permanent members of a new family share similar traits or challenges; they often fit into one or more of the following categories:
  • Seven years or older
  • Part of a sibling group that needs to be placed in a family together
  • A member of a minority group
  • Has disabilities which may include mental, physical and/or behavioral challenges
  • Is at risk for developing learning, emotional, behavioral or physical disabilities in the future
  • Was prenatally exposed to drugs or alcohol
Because children in foster care face instability and uncertainty, and because many have suffered neglect or abuse, all children in the foster care system are considered at increased risk for chronic physical, developmental, behavioral, or emotional conditions, and many of them require health or related services beyond the type or amount required by children generally, and so they are designated as Children and Youth with Special Health Care Needs (CYSHCN), either by diagnosis or circumstance. Each state, however, defines special needs differently for purposes of determining a child’s eligibility to receive adoption assistance when adopted from the foster care system.
Adoption is a special process, and many adoptive parents refer to finding and adopting their child as something that was "meant to be," but it is also a lot of work, and there are many important considerations to be made when adopting a child with special needs.
One point of consideration is the extra financial resources required to care for a child with special needs. Talking with the agency ahead of time to get an idea of what services and resources a child may need would be a good place to start. You will also want to check with your health insurance plan to verify coverage of the special care and services the child will require. Some plans may even offer adoption assistance.
Caring for children, especially those with special needs, may be draining, both physically and emotionally, for even the most prepared parents. Parents must remember that “caring for the caregiver” is equally as important, if not, at times, more important, than caring for their child. Your child’s health and well-being are dependent upon your overall health and stability.
Talking with other parents of children with some of the same special needs as your own child can be beneficial in understanding the essentials; other parents can help prepare you for the challenges, but they’ll also remind you of all the love and happiness you’ll share with your child. Disability specific support groups and organizations can connect parents with other families and community training sessions. Foster care and adoption agencies also offer training and support to parents before and after the adoption process; look to these agencies for assistance finding emotional support and training for your family.
If your child requires special accommodations, such as an adapted home (see Home Retro-fits and Switches) or vehicle for accessibility (see Wheelchairs and Adapted Strollers), you might find helpful information on other pages of the Medical Home Portal. Being as prepared and proactive as possible will make your adoption an easier transition, letting you focus on the much anticipated “welcome home” occasion for your child as you form a new family union.

Choosing an Agency

Each adoption is unique, and different circumstances will result in different requirements and procedures, different costs, and even different relationships between adopted children and their birth parents. For example, a “closed” adoption is one in which the birth parents and adoptive parents do not know each other’s identity, either before or after the adoption. In an open adoption, the birth parents and adoptive parents will exchange information, and may even arrange to meet with each other as the child grows, or they may simply maintain contact by telephone or email. There are also different types of agencies. You can choose the way and the agency that is right for you.
  • Public agency adoption or "Foster to Adopt" A public agency is supervised by a state or local Department of Health and Human Services and often has children with special needs who are looking for adoptive families. A public agency usually has more flexible and inclusive eligibility requirements for adoptive parents. Single parents, older parents, and parents with low incomes, who may find it difficult to qualify in other types of agencies, will more often meet the requirements of public agencies. Placement of a child can occur in as little as a few months, following a home study and approval. Because many foster parents adopt children that have been placed in their care, you may be approved as a licensed foster parent as well as a prospective adoptive parent in the same process. Adopting a child through the foster care system is often inexpensive, or even free. Some states will provide subsidies to help you with the cost of adopting a child.
  • Private agency adoption A private agency is privately funded. They usually work with infants from the local area or neighboring states, but sometimes they also work with children with special needs. A private agency may have more specific requirements (than a public agency) about who can adopt; for example, their eligibility requirements may be based on race, religion, or age. Placement through a private agency can take longer, often up to a few years following a home study and approval. According to the website, private agency adoptions can range from $5,000 to $40,000, depending on a variety of factors,including services provided, travel expenses, birthmother expenses, and requirements in the state.
  • Independent adoption An independent adoption is usually arranged through an attorney, physician, friend, or adoption counselor and each state may have its own specific requirements.
  • International adoption This is usually a more complicated process than domestic adoption, requiring additional paperwork, waiting lists, health concerns, travel, and the laws of the child’s birth country. International adoptions also vary significantly depending on the child’s birth country. The website states that the cost of international adoption can range from $7,000 to $30,000.
Although your adoption experience will be as unique as your child, there are common steps you must complete in order to welcome a child with special needs into your family:
  • Educate yourself on the adoption process and laws
  • Search for and select an agency
  • Complete an adoption application
  • Begin the home study process. (The home study is a comprehensive evaluation of you, your family, and your home environment, and is generally a required screening step in approving you as an adoptive parent.)
  • Receive approval for a placement
  • Search for a child
  • Meet and have pre-placement visits with the child
  • Prepare your home and your lives for your child's arrival
  • Begin building your own medical, educational, and community support network
  • Welcome your child into your family
  • Finalize your adoption


Information & Support

For Parents and Patients

National Foster Care & Adoption Directory Search
The National Foster Care & Adoption Directory (formerly the National Adoption Directory) offers adoption and post-adoption resources by state.

North American Council on Adoptable Children
North American Council on Adoptable Children provides information and resources on adoption.

Intercountry Adoption
US Department of State has extensive information and resources on international adoptions.

Children's Bureau
U.S. Department of Health and Human Services Administration for Children and Families, Children's Bureau, supports programs, research, and monitoring to help eliminate barriers to adoption and find permanent families for children.

Dave Thomas Foundation for Adoption
Dave Thomas Foundation for Adoption has information and resources.

The Adverse Childhood Experiences Study (CDC)
One of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being; Centers for Disease Control and Prevention.


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Authors & Reviewers

Initial Publication: February 2013; Last Update: February 2014
Current Authors and Reviewers (click on name for bio):
Author: Tina Persels
Authoring history
(Limited detail is available on authoring dates before 2014.)
AAuthor; CAContributing Author; SASenior Author; RReviewer