Adoption USA. A Chartbook Based on the 2007 National Survey of Adoptive Parents. Endnotes


1 See: U.S. Department of Health and Human Services, Administration for Children and Families. 2006. The basics of adoption practice. Available online at:

2 This subgroup may also include children who had birth parents unable or unwilling to provide adequate care but were not reported for abuse or neglect and, subsequently, not involved with public child welfare agencies. In these cases the birth parents must voluntarily relinquish their parental rights in order for a relative or unrelated individual to adopt the child privately.

3 Two additional variations on the way that private domestic adoption may occur include identified adoptions and the use of adoption facilitators. Identified adoptions are those in which adoptive and birth parents meet independently, but then choose to use some agency services, such as counseling. Adoption facilitators are sometimes used as an alternative to an adoption agency. An adoption facilitator is an individual who matches prospective adoptive parents and birth parents for a fee. In many states, adoption facilitators are minimally regulated, and in some, adoptions by paid facilitators are not legal. For details on variations in adoption methods, see: U.S. Department of Health and Human Services, Administration for Children and Families. 2003 Adoption Options.

4 For more information, see:

5 Individual studies, based on a variety of samples and methodologies, have estimated rates of disruption ranging from 10 to 25 percent, and rates of dissolution ranging from 1 to 10 percent. See: U.S. Department of Health and Human Services, Administration for Children and Families. 2004. Adoption Disruption and Dissolution. Available online at

6 During Federal Fiscal Year 2008 (October 1, 2007 through September 30, 2008), 4,123 children were adopted from Guatemala, more than any other country during that year. This was true even though adoptions from Guatemala had come to a halt by the end of that year. Data on rates of international adoptions to the United States and on trends in these rates are available from the Office of Children’s Issues of the U.S. Department of State, available online at: The rates are based on issuances of IR3, IH3, IR4, and IH4 visas. The type of visa varies depending on whether the child originates from a country that is party to the Hague Convention and depending on whether the adoption occurs in the United States or in the child’s home country.

7 Office of Children’s Issues of the U.S. Department of State,

8 The Voice of Russia World Service in English (RUVR). 2007. “Russian families’ change of heart on adoption.” Available
online at

9 Lee, Bong Joo. 2007. Adoption in Korea: Current status and future prospects. International Journal of Social Welfare. 16: 75-83.

10 Office of Children’s Issues of the U.S. Department of State,

11 Despite a spike in the number of foster care adoptions following the passage of the Adoption and Safe Families Act (ASFA) in 1996, evidence suggests that the likelihood that a waiting child will be adopted has not increased, and adoptive family recruitment has not increased the share of non-relative adoptions. During the three-year base period before ASFA, 28,000 children were adopted compared with 51,000 in FY 2000. Since 2002, the numbers of children adopted from foster care (51,000 to 53,000), the numbers waiting (129,000 to 133,000), and the percentages of waiting children who are adopted (38 to 40 percent) have remained fairly stable. [Trends in foster care and adoption: FY2002-FY2006 (based on data submitted by states as of January 16, 2008). Retrieved August 13, 2009 from:]

12 Jones, J. 2008. Adoption experiences of women and men and demand for children to adopt by women 18-44 years of age in the United States, 2002. National Center for Health Statistics. Vital and Health Statistics, 23(27). Available online at

13 The NSCH defines children with special health care needs as those who currently experience at least one out of five consequences attributable to a medical, behavioral, or other health condition that has lasted or is expected to last for at least 12 months. The consequences include: 1) ongoing limitations in ability to perform activities that other children of the same age can perform, 2) ongoing need for prescription medications, 3) ongoing need for specialized therapies, 4) ongoing need for more medical, mental health, or educational services than are usual for most children of the same age, and 5) the presence of ongoing behavioral, emotional, or developmental conditions requiring treatment or counseling.

14 Indeed, the experiences of adopted children and youth including histories of abuse and neglect, later age of adoption, prenatal drug exposure, and placement in multiple foster homes prior to adoption have been identified as risk factors for symptoms of attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) (Simmel, C., Brooks, D., Barth, R., and Hinshaw, S. 2001. Prevalence of externalizing symptomatology in an adoptive sample: Linkages between pre-adoption risk factors and post-adoption out-comes. Journal of Abnormal Child Psychology, 29:57–69). Attachment disorder, which can result from extremely neglectful care very early in life, is also a particular concern for adopted children who entered care due to severe neglect and/or who experienced multiple foster care placements early in life and for some internationally adopted children who received insufficient care in orphanages (for example, see: Howe, D., and Fearnley, S. 2003. Disorders of attachment in adopted and fostered children: Recognition and treatment. Clinical Child Psychology and Psychiatry, 8(3): 369-387; Hughes, D.A. 1999. Adopting children with attachment problems. Child Welfare, 78(5):541-560. Strijker, J., Knorth, E.J., and Knot-Dickscheit, J. 2008. Placement history of foster children: A study of placement history and outcomes in long-term family foster Care. Child Welfare, 87(5): 107-124; van den Dries, L., Juffer, F., van IJzendoorn, M.H., Bakermans-Kranenburg, M.J. 2009. Fostering security? A meta-analysis of attachment in adopted children. Children and Youth Services Review, 31(3): 410-421.)

15 See “Trends in Foster Care and Adoption—FY 2002-FY 2007,” available at

16 Adoptions of foster children facilitated by private agencies were intended to be categorized as foster care adoptions based on the NSCH screener questions. During the data collection, however, a change was made to the adoption type assignment for 73 children, because information regarding the type of adoption provided by the respondent during the NSAP interview conflicted with similar information provided during the NSCH interview. Nevertheless, survey error likely remains, and the population of former foster children in adoptions facilitated by private agencies is likely split between foster adoption and private domestic adoption in the NSAP.

17 Office of Children’s Issues, United States Department of State, available online at:

18 Weiguo Zhang. 2006. Child adoption in contemporary rural China, Journal of Family Issues 27(3): 301-340. Zeng Yi, Tu Ping, Gu Baochang, Xu Yi, Li Bohua, and Li Yongping. 1993. Causes and implications of the recent increase in the reported sex ratio at birth in China, Population and Development Review 19 (2): 283-302.

19 For a family of four, an income four times the federal poverty threshold equates to $84,800 in 2008. (See: The 2008 HHS Poverty Guidelines, One Version of the [U.S.] Federal Poverty Measure, available at

20 Overall, six out of ten adopted children live with two married adoptive parents, most of whom were also married at the time of adoption (55 percent of adopted children have parents who were married at the time of the adoption; an additional 5 percent live with parents who married since the adoption).

21 According to the NSAP, 74 percent of children live with a parent who has a spouse or partner (i.e., the spouse or partner may or may not be an adoptive parent and may or may not be married to the child’s other parent) compared with 80 percent of the general population of children.

22 See: U.S. Census Bureau, page last modified August 19, 2009. Metropolitan and Micropolitan Statistical Areas, available online at:

23 The 16 conditions considered for the measure of moderate or severe health difficulties include: learning disability; attention deficit disorder or attention deficit hyperactivity disorder (ADD/ADHD); depression; anxiety problems; behavioral or conduct problems, such as oppositional defiant disorder or conduct disorder; autism, Asperger's disorder, pervasive developmental disorder, or other autism spectrum disorder; any developmental delay that affects his/her ability to learn; stuttering, stammering, or other speech problems; Tourette's syndrome; asthma; diabetes; epilepsy or seizure disorder; hearing problems; vision problems that cannot be corrected with glasses or contact lenses; bone, joint, or muscle problems; and brain injury or concussion.

24 This finding is consistent with prior research that focused on the disproportionately high prevalence of clinical levels of externalizing disorders in adopted youth, such as ADHD/ADD, Oppositional Defiant Disorder, conduct disorders, and antisocial behaviors (Deutsch, C.K., Swanson, J.M., Bruell, J.H., Cantwell, D.P., Weinberg, F., and Baren, M. 1982. Over-representation of adoptees in children with attention deficit disorder. Behavior Genetics, 12, 231-238. Brodzinsky, D.M., Hitt, J.C., and Smith, D. 1993. Zill, N. 1996. Coon, J., Carey, G., Corley, R., and Fulker, D.W. 1992. Identifying children in the Colorado Adoption Project at risk for conduct disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 503-511. Simmel, C., Brooks, D., Barth, R., and Hinshaw, S. 2001. Prevalence of externalizing symptomatology in an adoptive sample: Linkages between pre-adoption risk factors and post-adoption outcomes. Journal of Abnormal Child Psychology, 29:57–69).

25 For a review, see the Child Trends Databank indicator on “Reading to Young Children,” available online at:

26 For a review, see the National Center for Education Statistic’s article “Reading—Young Children’s Achievement and Classroom Experiences” available online at:

27 For a review, see the Child Trends Databank indicator on “Family Meals,” available online at:

28 For a review, see the Child Trends Databank indicator on “After-School Activities,” available online at:

29 See Frosch, C. A., & Mangelsdorf, S. C. (2001). Marital behavior, parenting behavior, and multiple reports of preschoolers' behavior problems: Mediation or moderation? Developmental Psychology, 37, 502-519.

30 A small minority of children whose parents reported that they didn’t know they were adopted were excluded from this analysis. Overall, 3 percent of adopted children ages 5 and older do not know they are adopted.

31 See “Adoption Benefits Increased” at,,id=177982,00.html.

32 Kahan, M. 2006. “Put up” on platforms: A history of twentieth century adoption policy in the United States. Journal of Sociology and Social Welfare, 33(3): 51-72.

33 Ibid. See also Brodzinsky, D.M. 2005. Reconceptualizing openness in adoption: Implications for theory, research, and practice. Pp. 145-166 in Psychological Issues in Adoption (D.M. Brodzinsky and J. Palacios, eds.) Westport, CT: Greenwood Publishing Group.

34 As of 2008, this was true in 23 states. Child Welfare Information Gateway. 2005. Post adoption contact agreements between birth and adoptive families: Summary of state law. Available online at:

35 For a more thorough description of post-adoption supports, see

36 Further information on the NSCH can be found in: Blumberg S.J., Foster E.B., Frasier A.M., et al. Design and Operation of the National Survey of Children’s Health, 2007. National Center for Health Statistics. Vital and Health Statistics, Series 1. Forthcoming. Available online at

37 Federal officials and contractor staff consulted with the State Department’s Office of Children’s Issues during the development of the NSAP instrument to gain insight on the questions pertaining to international adoptions.

38 The NSAP was also administered as a follow-back to the 2005-06 National Survey of Children with Special Health Care Needs (NS-CSHCN). The present chartbook does not include results from the National Survey of Adoptive Parents of Children with Special Health Care Needs (NSAP-SN). Initial results based on the identification of adopted children in the NS-CSHCN are available in: Bramlett, M.D., and Radel, L.F. 2008. Adopted children with special health care needs: Characteristics, health, and health care by adoption type. ASPE Research Brief. Washington, DC: Office of the Assistant Secretary for Planning and Evaluation, Office of Human Services Policy – U.S. Department of Health and Human Services. Available online at

39 Further information on the NSAP can be found in: Bramlett MD, Foster EB, Frasier AM, et al. Forthcoming. Design and Operation of the National Survey of Adoptive Parents, 2007. National Center for Health Statistics. Vital and Health Statistics, Series 1.

40 Specifically, the overall NSAP response rate depended upon the resolution rate (i.e., the identification of sampled telephone numbers as being residential or non-residential), the age screener completion rate for determining eligibility for the NSCH, the NSCH interview completion rate, and the NSAP eligibility screener completion rate, in addition to the NSAP completion rate. For more details, see Bramlett et al., forthcoming.

41 The legal relinquishment of biological parents’ rights to their children, and the legal adoption of children by non-biological children, are two separate steps that must take place in sequence for an adoption to occur.

42 For a review, see Gibson, P.A., J. Nelson-Christinedaughter, H.D. Grotevant, and H-K. Kwon. 2005. The well-being of African American adolescents within formal and informal adoption arrangements. Adoption Quarterly, 9(1), 59-78.

43 For a review, see Kreider, 2003.

44 Kreider, 2003. The Census report notes that this estimate is likely to be an undercount of the number of step-children due to the manner in which the data were collected. Additionally, in the Census, families simply reported whether or not their child was a “stepson/stepdaughter” or without identifying whether or not the householder had adopted that stepchild.

45 The two samples of adopted children are not identical because, as noted above, some focal children who were identified as adopted in the NSCH had parents who did not participate in the NSAP interview.

46 In the public use version of the NSAP data, the 51 strata for the 50 states plus Washington, DC have been collapsed into ten categories in order to protect respondent confidentiality. The chartbook analyses of the NSAP sample use the original, un-collapsed state identifier as the PSU identifier. Analyses of the NSCH data presented in this chartbook also use the state as the PSU identifier. Although the state was used as the PSU identifier, reliable state-level estimates cannot be calculated from the NSAP sample due to small sample size by state.

View full report


"index.pdf" (pdf, 1.42Mb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®