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Things That Can Go Wrong in an Adoption: Unknown/Unexpected Health Conditions

Kathryn Patricelli, MA

Another common fear adoptive parents have is that they will find out about a physical or mental health condition they did not know about when starting the adoption. This sort of risk, unfortunately, is not always preventable, despite parent's best efforts to screen out difficulties. Those choosing to adopt must be aware of the possibility that they may end up with a child who has health problems. Many medical conditions or family histories will not present themselves until the child is older. When and if health concerns occur, the family and the child will have to deal with them as would anyone who finds out they or their child have a medical condition.

Two conditions that have become more familiar to those adopting, and which are more common in children who have been seriously abused or neglected, moved around to many foster homes, or resided in institutional care (orphanages, etc.), are Reactive Attachment Disorder (RAD) and Oppositional Defiant Disorder (ODD).

With RAD, an infant experiences problems in forming strong and trusting attachments to their caregivers. The child has difficulty bonding with its new adoptive parents. RAD can result in the child having problems creating and sustaining relationships and in learning language and appropriate social behavior. Speech issues and other development delays/problems may occur as a result. Some RAD children act out their frustrations in rather cruel ways on other people and animals/pets. RAD is not generally "cured,” but when addressed early on with treatment, the family and child can learn ways to manage the emotions and behaviors so as to keep the child on a proper developmental track.

ODD involves hostile or defiant behavior toward caregivers that goes well beyond what may be typical for a child or teen. The behavior is extreme and involves arguing with others, being defiant about following rules, and generally hostile behavior. While some children will outgrow ODD as they get older, others will require professional treatment before their troubling behavior can be brought under control. Very young children benefit from behavioral therapy, as do their parents, who often benefit from learning how to discipline their children properly and effectively. Teenaged children are less responsive to parental discipline or attempts at therapy. Some portion of ODD-diagnosed teens will go on to have the condition into and throughout adulthood, where it is frequently labeled "Antisocial Personality Disorder."

Apart from RAD and ODD, children who spent time in institutional settings may have other behavioral or emotional problems. When the care received was minimal or inadequate, the child may have problems trusting and relying on adults. They may have issues relating to or getting along with other children in the family or in school. They may hoard food or other items. When families see this type of behavior, it will often be necessary to seek some type of counseling for both the child and family early on so that the issues can be addressed and the family can learn ways to reassure the child that things will be different and better now that they are with their adopted family. Self-protective behaviors that are now counter-productive may now safely be relinquished.