As a sample survey, the NS-CSHCN was subject to non-random error, including coverage bias and nonresponse bias. In addition, these survey findings are based on parents’ experiences and perceptions about children’s health. Information provided about health care status and services was not verified with health care professionals.
The NS-CSHCN question that identified adoptions from foster care reads: “Was (sample child) residing in foster care prior to being placed for adoption? This includes children placed by private agencies on behalf of a state or county child welfare agency.” This question does not allow us to distinguish between CSHCN adopted by their foster parents from CSHCN in foster care adopted by people other than their foster parents, such as relatives or by families previously unknown to the child. The question also does not allow us to distinguish CSHCN adopted directly from foster care from CSHCN adopted through a private agency some time after residing in foster care. Thus, the phrase, “adopted from foster care” should not be interpreted to specifically mean “adopted by the foster parents” or “adopted directly from foster care.” It simply means, “adopted after having lived in foster care.” Analyses based on the 2007 National Survey of Children’s Health and the National Survey of Adoptive Parents, to be released in early 2009, will be able to distinguish children adopted by their foster parents from children adopted after foster care by persons other than their foster parents.
Private domestic adoptions, other than step-parent adoptions which were excluded from our analysis, almost always involve infants (Evan B. Donaldson Adoption Institute, no date; Child Welfare Information Gateway, 2003). However, our results indicate that only slightly more than half of CSCHN adopted from private domestic sources were under age 1 at adoption and one third were two years of age or older at adoption. This is likely an artifact of sample design. Prevalence of CSHCN is lower at younger ages (US DHHS, 2007), presumably because there has been less opportunity to recognize the health problems of the child or because the child’s health problems develop or become more noticeable as the child ages. It is also possible that some CSHCN are placed for adoption at older ages because of health problems that were not evident at birth or that over time became more than their families could handle. This once again underscores the importance of not generalizing these results to the population of all adopted children.