Children adopted from care will have experienced trauma and loss, even if they were adopted shortly after birth. Some may have additional needs resulting from physical, mental or emotional problems or disabilities.
When a possible match is suggested with you and a child, this is often an exciting time. It is important that you find out as much as possible about the child's health history and needs, so that if you decide to go ahead with the match, you will be as well informed as possible. Having realistic expectations will increase the chances of a successful adoption.
Your adopted child's health history
When children go into care (become 'looked after') or have a plan for adoption, the law requires a detailed assessment of their health. A report on their health should include information on:
- their mother's pregnancy, their birth and early development
- their birth family's medical history
- their own medical history, including any experiences of abuse and neglect, and a chronological list of any immunisations, injuries and illnesses they've had
- their current physical health, including vision, hearing and dental care
- their mental health and behaviour, including experiences of trauma and loss
It can sometimes be difficult to get all this information. For example, birth parents may not want to share information about their child if they are unhappy with the plans being made. Sometimes they may be absent or the father may be unknown. Not having full health information can make it harder to understand a child's difficulties and to predict what will happen in the future.
However, the medical assessments that a child will have had throughout their time in care means there should be existing information on their health by the time they're adopted.
Under care planning requirements for looked-after children:
- Health assessments should take place at least every six months for children aged four and under, and at least every 12 months for children aged five and over.
- Where possible, birth parents should be involved as they can help to provide more detail about the child's medical and birth family medical history.
- Based on the report of the child's health needs assessment, a health plan is developed, including any current arrangements for their healthcare and details of further healthcare that may be required.
Increasingly, it is accepted as good practice for the adoption agency's medical adviser to meet with the prospective adopters to discuss the child's health. This provides them with a better understanding of the child's needs, any gaps in their health information, and an opportunity to ask questions about the child's health. The medical adviser should then provide them with a written report, which documents what they have been told.
If the adoption goes ahead, a copy of the health assessment report will be sent to your child's GP as well as to you. You may want to discuss this with your GP, or ask your GP to talk to the medical adviser on your behalf. This can happen even after an adoption order has been made.
Parents of older adopted children often find post-adoption that medical appointments can be particularly difficult for the child as the subject of their adoption often arises, for example, if the doctor asks about family medical history. Anything you can do to help the appointment go smoothly, such as making sure the GP is aware of the situation in advance, will help your child feel more comfortable.
Developmental delays in adopted children
For a child who has been taken into care, the extent to which their development may be delayed can vary greatly. The delay can be physical or emotional, or both – the child may act younger than their age, or be unable to do things most children their age can do. Or the delay can relate to a specific area, such as their speech.
Developmental delays in looked-after and adopted children can be caused by the following factors:
- The delays have been caused by something that happened during the mother's pregnancy, such as her alcohol or drug use. This can lead to the child being diagnosed with foetal alcohol syndrome (FAS) or a foetal alcohol spectrum disorder (FASD).
- Extreme and prolonged levels of stress or anxiety during pregnancy have also been shown to be damaging to the unborn child, affecting their brain development.
- The child's environment after they are born may affect their development, such as developmental trauma caused by abuse or neglect, or both. If they are not properly cared for and stimulated, this affects the growth and development of certain areas of their brain leading to a lack of emotional development. This is often referred to as "attachment difficulties" or "attachment disorder".
- Some delays may be characteristic of genetic conditions, such as Down's syndrome.
Different children have different levels of resilience to delays caused by trauma in the womb or abuse and neglect after birth. They also have different capabilities to overcome this trauma and "catch up" developmentally.
It can be difficult to predict the long-term impact of these delays. This means that potential adopters need to accept there may be uncertainty around whether their adopted child will need specialist support services in the future. It takes a lot of perseverance, patience and determination from parents to help children overcome their difficulties, but post-adoption support is available.
Parenting neglected children
While some children in the care system may have been physically or sexually abused at some point in their lives, many of them are being looked after because their basic needs have been neglected. Studies show that neglect, such as being deprived of food or care, is often more damaging to the child than individual episodes of abuse.
Professor Peter Fonagy is chief executive of the Anna Freud Centre in London, which conducts research into attachment disorders and child mental health. He says: "The more dramatic reasons for children being taken into care, such as sexual or physical abuse, have in fact been shown to be less toxic experiences than long-term neglect. Yet neglect is more subtle and more likely to be overlooked by other adults in the child's life."
Both abuse and neglect can lead to psychological problems in children, including issues around trusting adults, which can take many years to overcome. Professor Fonagy explains that this is because they are in a state of "hyper vigilance". He says: "Children who have had bad experiences, particularly in care, are on high alert and don't believe anything anyone tells them because they don't trust them. They're shut off. They understand what they're being told but won't bring it into their own world as a truth, and they can't modify their own belief that they are not loved or that they are 'bad'."
For this reason, adopted children will not only need love and care from their adoptive parents. "There are good treatments available for a lot of childhood mental disorders," says Professor Fonagy, who has worked to improve children and young people's access to psychological therapies.
Ask your local authority or social worker about therapeutic parenting courses available to you, such as Theraplay, life story work and TAPPs courses (Trauma Attachment and Preparation for placement).
Find out more about post-adoption support.
Eating anxieties in children who have been adopted
Looked-after and adopted children often have food anxieties linked to their early experiences.
- hoarding food
- stealing food
- problems eating certain foods, such as solids and specific textures
For example, if a child has experienced not being fed enough or regularly, this could lead to them overeating or hoarding food even after they have been placed with their adoptive family. This is because they may not fully trust that another meal will come.
Caroline Archer, author and adoptive parent of four children, has the following advice:
- Keep mealtimes as low-key as possible and set regular meal routines.
- Provide small amounts of the things your child enjoys and slowly introduce new tastes and textures.
- Never demand they eat up or finish anything – but let them know you expect them to try.
- Watch out for foods that seem to be a trigger for memories of early traumas.
Find out more about eating disorders.
Adopting a child with a medical condition, disability or special or additional needs
Some children needing adoptive families have complex medical conditions. Those with conditions such as cerebral palsy, cystic fibrosis, Down’s syndrome or foetal alcohol spectrum disorder (FASD) need parents who can meet their needs and act as effective "advocates" to make sure their children get the services they require.
Many children will also have needs relating to trauma due to neglect or abuse, in addition to their physical or medical difficulties.
Additionally, some children may have a vulnerability to some psychological conditions, such as depression or anxiety, which can be inherited. Rarer conditions that may emerge in adolescence or later, such as psychotic illnesses, may also have a genetic risk factor.
Questions to ask your child's adoption agency medical adviser and social worker
- What is the extent of my child's medical or physical disability (if they have one), and should we discuss this with a medical specialist?
- What services does my child use at the moment (such as physiotherapy or speech therapy) and how frequent are the appointments, where are they held and who co-ordinates the medical services?
- How can I care for my child's additional needs at home, as part of a daily routine?
- What changes will I need to make to my home and car to support my child's condition? Is there funding available to make this possible?
- What plans have been put in place to ensure continuity of care and ensure that all their medical records are transferred to their new GP?
- What benefits are my child and I entitled to after placement, such as a Disability Living Allowance or a carer's allowance?
- Does my child have a statement of special educational needs (SEN), and if so, what provisions does the statement include?
- Would my child benefit from remaining in a class with younger children for a while, or even staying at home? What changes or adaptations should the school make?
- If my child doesn't have a statement of SEN, is that because they don't have any special educational needs or because they don't have needs that require a statement?
- If I think my child might have special educational needs that have not yet been identified, how should I go about getting an assessment?
- Are there any hereditary health conditions in the child's birth and extended family that may appear later in their life?
- How can we get further information about the child's family and medical history in the future?
More information on adoption health needs
You may find the following resources helpful:
- The FASD Trust raises awareness of foetal alcohol spectrum disorders and has a helpline, while The National Organisation for Foetal Alcohol Syndrome (NOFAS) supports people affected by FASD, as well as their families and communities.
- Family Futures is an adoption and therapy agency offering therapeutic help to children who have experienced trauma and are living in birth families, foster homes or adoptive families.
- Post Adoption Centre (PAC) also supports birth families and relatives as well as adopted children and their adoptive families.
- Adoption Plus offers an adoption placement service, specialist therapy services and training and conferences.
- Parenting Advice for Foster Carers and Adopters (PAFCA) is run by clinical child psychologist, Dr Amber Elliott, who specialises in early trauma, adoption and fostering.
- The Adopter's Handbook, published by CoramBAAF, has information on every aspect of adoption including legal and financial matters, and schooling and education.
- CoramBAAF also publishes a series of parenting handbooks, Parenting Matters, covering issues including developmental delay and parenting children affected by their birth parents' substance abuse.
- Contact a Family is a national charity that supports the families of disabled children whatever their condition or disability.
- Young Minds is a charity committed to improving the emotional wellbeing and mental health of children and young people.
- Visit the NHS Choices sections for learning disabilities, physical disabilities and carers.