Special needs adoption in France and USA 2016: How can we best prepare and support families?

More than 700,000 children were adopted internationally between 1990 and 2014. The USA and France have been among the top receiving countries in these years. Recently, many factors, including the ratification of the Hague Convention on Inter-country Adoption, have favored domestic adoption for children in need of families. As a result, the number of inter-country adoptions has declined considerably. Concurrently, the proportion of internationally adopted children with defined special needs has risen dramatically. These special needs may be generally categorized as medical issues (such as physical disabilities), age (> 5 years), or being part of a sibling group. Additional special needs, frequently behavioral or emotional problems, are often diagnosed after evaluation in the receiving country. These changing trends have greatly modified the need for and type of pre-adoption preparation of prospective adoptive parents, as well as for post-adoption support for these families and their children. In this review, the authors comprehensively analyze pediatric and child psychiatric considerations for preparing and supporting families and children. Based on clinical and epidemiological studies, as well as parent questionnaires, the need for pediatric and child psychiatric support before and after the arrival child is confirmed. Consultations with professionals specializing in international adoption can provide needed advice, diagnosis, and treatment tailored to the origin of the child and his prior experiences. The high prevalence of behavioral and emotional problems often justifies the need for psychological and child psychiatric guidance. Thus, the changing trends in inter-country adoption emphasize the needs for comprehensive support linked to the specific needs of these children.