Previous research has found that although most adopted children are in good health, they are at increased risk across a range of developmental domains. Studies are consistent in finding particularly elevated risks of mental health problems (Miller, Fan, Cristensen, Grotevant and van Dulmen, 2000; Nickman, Rosenfeld, Fine, et al., 2005; Brodzinsky, 1993). Even children adopted in infancy have been found to have moderately higher risks for having a disruptive behavior disorder as adolescents (Keyes, Sharma, Elkins, Iacono and McGue, 2008). Clinics specializing in the physical health needs of adopted children have been established in many large cities, making adoption medicine a new specialty (Nicholson, 2002; Tuller, 2001). The American Academy of Pediatrics established a specialty section on foster care and adoption medicine in 2000 (http://www.aap.org/sections/adoption/default.cfm).
Analysis of the 2003 National Survey of Children’s Health found that adopted children are more likely than biological children (i.e., children living with at least one biological parent) to have special health care needs, moderate or severe health problems, developmental delay or physical impairment, learning disability, and other mental health difficulties. Parents of adopted children were more than five times more likely than parents of biological children to report ever being told that their child had a developmental delay or physical impairment (16% versus 3%). Nearly 20% of adopted children were reported by their parents to have moderate to severe current health problems compared with 7% of biological children, and 37% of adopted children had special health care needs as compared with 17% of biological children (Bramlett, Radel and Blumberg, 2007).
While there is a considerable literature on the special health care needs of adopted children, this literature is limited by a number of factors. First, studies often rely on small clinical samples that are not representative of a broader population. Second, studies typically include only one type of adoption (e.g. children adopted from foster care), making comparisons among adoption types impossible. Finally, studies that contain a broad cross section of adopted children have most often identified adopted children within data sets collected for other purposes that lack information with which to identify subgroups by factors such as adoption type and age at adoption that may be related to special health care needs.