U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of the Assistant Secretary for Planning and Evaluation

Adoption USA

A CHARTBOOK BASED ON THE

2007 NATIONAL SURVEY OF ADOPTIVE PARENTS
Adoption USA

A Chartbook Based on the 2007 National Survey of Adoptive Parents

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of the Assistant Secretary for Planning and Evaluation

Authors:

Sharon Vandivere and Karin Malm

Child Trends

Laura Radel

U.S. Department of Health and Human Services

Office of the Assistant Secretary for Planning and Evaluation
ii

Material contained in this publication is in the public domain and may be reproduced, fully or partially,

without permission of the Federal Government. The courtesy of attribution is requested. The suggested

citation is as follows:

Vandivere, S., Malm, K., and Radel, L. Adoption USA: A Chartbook Based on the 2007 National Survey of

Adoptive Parents. (Washington, D.C.: The U.S. Department of Health and Human Services, Office of the 

Assistant Secretary for Planning and Evaluation, 2009).

A public use data set for the National Survey of Adoptive Parents is available to researchers. For more 

information see: http://www.cdc.gov/nchs/slaits/nsap.htm. In addition, the Adoption USA chartbook may

be found at http://aspe.hhs.gov/hsp/09/NSAP/chartbook/. Printed copies are available from the Child 

Welfare Information Gateway (www.childwelfare.gov or 800-394-3366). 
iii

Acknowledgements

Any large scale research effort is made possible through the efforts of many hands, and the 

National Survey of Adoptive Parents (NSAP) and the compilation of this Chartbook is no exception. 

Important to this effort is the interagency collaboration that occurred throughout the development 

of the questionnaire, the implementation of the survey, and, finally, the publication of the Chartbook. 

The NSAP was sponsored by the Office of the Assistant Secretary for Planning and Evaluation (ASPE)

and the Children’s Bureau within the Administration for Children and Families (ACF). In 2005-06 the

Urban Institute developed the questionnaire used in the survey under contract to the Office of the 

Assistant Secretary for Planning and Evaluation (233-02-0092, task 10). The survey was conducted 

in 2007-08 by the Centers for Disease Control and Prevention’s (CDC) National Center for Health 

Statistics (NCHS) as a module of the State and Local Area Integrated Telephone Survey (SLAITS). 

The CDC’s National Center for Immunization and Respiratory Diseases graciously permitted the 

use of the National Immunization Survey sampling frame for this survey. Data collection was 

conducted by the National Opinion Research Center (NORC) at the University of Chicago under 

contract to the NCHS. 

In 2008-09 this Chartbook was developed by Child Trends under contract to the Office of the 

Assistant Secretary for Planning and Evaluation (HHSP233200800506G). The Child Trends authors

would like to acknowledge the assistance of many individuals in the data analysis and development 

of the Chartbook. First, we wish to express our thanks to our Federal Project Officers, Laura Radel 

with the Office of the Assistant Secretary for Planning and Evaluation and Matthew Bramlett with 

the National Center for Health Statistics, for their invaluable oversight and input throughout the 

development of this Chartbook. In addition, Dr. Bramlett was the NSAP survey director and provided

valuable insights with his extensive statistical expertise. We also wish to thank the expert consultants

who reviewed drafts of this Chartbook and helped to identify key themes and suggested ways to clarify the presentation: Richard Barth, Professor and Dean of the University of Maryland School of Social

Work; Penelope Maza, former Senior Policy Research Analyst in the U.S. Children’s Bureau; and Debbie

Riley, Executive Director, The Center for Adoption Support and Education. In addition, Child Trends

senior staff member David Murphey reviewed early drafts of the Chartbook and provided valuable 

insight. Erin Bishop, former research assistant at Child Trends, was an integral part of the team, 

diligently conducting analytical tasks. The Chartbook was designed by Chris Mazzatenta.

Most importantly, we extend our appreciation to the thousands of parents who were willing to 

share their stories. Their efforts made this Chartbook a reality.
iv
v

INTRODUCTION ........................................................................................................1

The adoption process .................................................................................................................. 1

Interpreting differences among percentages ............................................................................ 3

Changes in the adoption landscape ............................................................................................ 4

All adopted children .................................................................................................................... 5

Children adopted from foster care.............................................................................................. 6

Children adopted domestically from sources other than foster care........................................ 6

Children adopted from international sources ............................................................................ 7

The Chartbook .............................................................................................................................. 7

PART 1: THE POPULATION ........................................................................................9

Children’s history, prior relationship with parents....................................................................11

Race, ethnicity, and gender ........................................................................................................13

Other demographic and socio-economic characteristics.......................................................... 15

Family structure .......................................................................................................................... 17

Neighborhood characteristics.................................................................................................... 19

Physical health ............................................................................................................................ 21

Social and emotional well-being .............................................................................................. 25

Cognitive development and educational achievement .......................................................... 28

Family and community activities .............................................................................................. 30

Parenting and parent well-being .............................................................................................. 32

Adoption satisfaction ................................................................................................................ 35

Parent involvement and advocacy in the adoption community.............................................. 36

Parents’ prior connections to adoption .................................................................................... 38

PART 2: THE ADOPTION PROCESS ........................................................................40

Parents’ motivation to adopt .................................................................................................... 41

Parents’ satisfaction with their agency or attorney ................................................................ 42

Adoption expenses .................................................................................................................... 43

Adoption openness .................................................................................................................... 45

Post-adoption supports.............................................................................................................. 47

TECHNICAL APPENDIX............................................................................................50

Data sources................................................................................................................................ 50

Identifying adopted children and the type of adoption ........................................................ 51

Data analysis .............................................................................................................................. 51

Availability of data .................................................................................................................... 52

ENDNOTES ..............................................................................................................53

Adoption USA

A Chartbook Based on the 2007 National Survey of Adoptive Parents
LIST OF FIGURES

Figure 1. Number and percentage distribution of adopted children by adoption type .......................................................... 3

Figure 2. Percentage of adopted children who have ever lived with birth family members, by adoption type ..................11

Figure 3. Percentage of children adopted from foster care and from other dometic sources who have ever lived 

with birth family members, by pre-adoptive relationship to parents ......................................................................11

Figure 4. Percentage distribution of all children and adopted children by race and Hispanic origin ....................................13

Figure 5. Percentage distribution of adopted children by race and Hispanic origin, by adoption type ................................14

Figure 6. Percentage distribution of adopted children by race and Hispanic origin of their parents, by adoption type ....14

Figure 7. Percentage of adopted children who were adopted transracially, by adoption type ............................................14

Figure 8. Percentage distribution of all children and adopted children by child age ............................................................15

Figure 9. Percentage of adopted children by socio-economic and demographic characteristics, by adoption type ............16

Figure 10. Percentage distribution of adopted children by existence of birth siblings; percentage distribution of 

adopted children with birth siblings by whether or not parent also adopted child’s birth sibling(s) ..................17

Figure 11. Percentage of adopted children with birth siblings also adopted by parent, by adoption type ..........................18

Figure 12. Percentage of children with married parents, by adoptive status and by adoption type ....................................18

Figure 13. Percentage of adopted children in families with both adopted and biological siblings, by adoption type ........18

Figure 14. Percentage of children living in neighborhoods with various characteristics, by adoptive status........................19

Figure 15. Percentage of children according to their health status, by adoptive status........................................................ 21

Figure 16. Percentage of adopted children according to their health status, by adoption type .......................................... 22

Figure 17. Percentage of children according to measures of health context and insurance, by adoptive status ................ 22 

Figure 18. Percentage of adopted children according to measures of health context and insurance, by adoption type .. 23

Figure 19. Percentage of children according to measures of social and emotional well-being, by adoptive status............ 26

Figure 20. Percentage of adopted children according to measures of social and emotional well-being, 

by adoption type........................................................................................................................................................ 26

Figure 21. Percentage of children ages 6-17 who spend any time reading on an average school day, by adoptive 

status and by child age.............................................................................................................................................. 28

Figure 22. Percentage of children ages 6-17 who are usually or always engaged in school, by adoptive status 

and by adoption type ................................................................................................................................................ 29

Figure 23. Percentage of adopted children ages 5-17 whose parents rated school performance as “excellent” or 

“very good,” by adoption type ................................................................................................................................ 29

Figure 24. Percentage of children whose parents read to them and sing or tell stories to them, by adoptive status ........ 30

Figure 25. Percentage of children ages 6-17 who participate in one or more organized activities outside of school, 

by adoptive status and by adoption type ................................................................................................................ 31

Figure 26. Percentage of adopted children according to parenting and parent-child measures.......................................... 33

Figure 27. Percentage distribution of all children and all adopted children, by reported satisfaction of parent with 

spouse/partner relationship quality .......................................................................................................................... 34

Figure 28. Percentage of adopted children according to parenting and parent-child measures, by adoption type .......... 34

Figure 29. Percentage of adopted children according to whether their parents would make the same decision to 

adopt again, by adoption type ................................................................................................................................ 35

Figure 30. Percentage distribution of adopted children according to whether parents helped other adoptive families .. 36

Figure 31. Percentage distribution of adopted children according to whether parents recruited other adoptive families .... 36

Figure 32. Percentage distribution of adopted children according to whether parents helped other adoptive families, 

by adoption type........................................................................................................................................................ 37

Figure 33. Percentage distribution of adopted children by parents’ prior connection to adoption .................................... 38

Figure 34. Percentage distribution of adopted children by parents’ prior connection to adoption, by adoption type ...... 38

Figure 35. Percentage of adopted children by parents’ reasons for choosing to adopt, by adoption type.......................... 41

Figure 36. Percentage distribution of adopted children by parents’ reported experience with adoption 

agency or attorney, by adoption type ...................................................................................................................... 42

Figure 37. Percentage distribution of adopted children by cost of the adoption, by adoption type.................................... 44

Figure 38. Percentage of children adopted by non-relatives who have pre-adoption agreements regarding openness 

and who have had post-adoption contact with birth family members, by adoption type .................................. 45

Figure 39. Percentage of adopted children whose parents wanted to receive various post-adoption services 

(adoption specific) but did not ..................................................................................................................................47

Figure 40. Percentage of adopted children whose parents received various post-adoption services 

(adoption specific), by adoption type ...................................................................................................................... 48

vi
LIST OF FIGURES CONTINUED

Figure 41. Percentage of adopted children whose parents wanted to receive various post-adoption services 

(general) but did not.................................................................................................................................................. 49

Figure 42. Percentage of adopted children whose parents received various post-adoption services 

(general), by adoption type........................................................................................................................................49

LIST OF APPENDIX TABLES

Table 1. Number and percentage distribution of children ages 0-17 by adoptive status; number ................................................ 56

and percentage distribution of adopted children ages 0-17 by various characteristics

Table 2. Children’s history and prior relationship to parents ...................................................................................... 58

Table 3. Race, ethnicity, gender, and country of origin................................................................................................ 59

Table 4. Other demographic and socio-economic characteristics................................................................................ 60

Table 5. Family characteristics and structure ................................................................................................................ 62

Table 6. Neighborhood characteristics .......................................................................................................................... 63

Table 7. Physical health and factors related to health.................................................................................................. 64

Table 8. Social and emotional well-being...................................................................................................................... 66

Table 9. Cognitive development and educational achievement.................................................................................. 68

Table 10. Family and community activities and context..................................................................................................69

Table 11. Parenting and parent well-being .................................................................................................................... 70 

Table 12. Adoption satisfaction........................................................................................................................................ 72

Table 13. Parent involvement in adoption community/advocacy .................................................................................. 73

Table 14. Parents' prior experience with adoption ........................................................................................................ 74

Table 15. Parents' motivation to adopt .......................................................................................................................... 74

Table 16. Parents’ satisfaction with their attorney or agency........................................................................................ 75

Table 17. Adoption expenses............................................................................................................................................ 76

Table 18. Openness of adoption ...................................................................................................................................... 77

Table 19. Receipt of post-adoption services .................................................................................................................... 78

vii
viii
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 1

This Chartbook presents findings from the

2007 National Survey of Adoptive Parents

(NSAP). The NSAP is the first-ever survey to

provide representative information about the

characteristics, adoption experiences, and wellbeing of adopted children and their families in

the United States. All information was reported

by the children’s adoptive parents. The findings

represent children under age 18 who were

adopted and living with neither biological

parent. This includes children adopted from

foster care, from other domestic sources, and

from other countries. Furthermore, the

Chartbook includes comparable information 

on children in the general population for many

indicators of well-being, based on data from 

the 2007 National Survey of Children’s Health

(NSCH). While adopted children comprise 

only a small portion of the overall U.S. child

population—about 2 percent—their absolute

numbers are sizable, numbering nearly 1.8

million.i This group of children is of particular

concern to policy makers and the public both

due to the government’s role in establishing

adoptive parent-child relationships as well as 

the potential vulnerabilities of some segments 

of this population.

THE ADOPTION PROCESS

Adoption establishes a legal parent-child

relationship between a child and one or two

adults who are not the child’s biological parents.

Once finalized, adoption affords adoptive

parents rights and responsibilities identical to

those of biological parents. Except for children

in step-family adoptions, who are not examined

in this Chartbook, children who have been

adopted all share the experience of being raised

by parents who are not their biological parents.

Adoptive parents also share common

Introduction

ABOUT THE DATA SOURCES

The National Survey of Children’s Health (NSCH) is a nationally representative survey of U.S. children under 

age 18. In each sampled household, one child under age 18 was randomly selected. A parent or guardian

knowledgeable about the child’s health answered questions by telephone regarding the child’s and the family’s

health and well-being and provided information about demographic characteristics. The 2007 NSCH includes

information on 91,642 focal children, representing 73.8 million children throughout the United States.

The National Survey of Adoptive Parents (NSAP) was an add-on module to the 2007 NSCH. If the focal child in

the 2007 NSCH was adopted, an adoptive parent of the child was asked to participate in the NSAP, a 30-minute

telephone survey. A total of 2,737 focal children were identified as having been adopted in the 2007 NSCH.

NSAP interviews were carried out between April 2007 and June 2008 regarding 2,089 children, representing

nearly 1.8 million children throughout the nation. Adopted children who were also living with a biological

parent, whose adoptions were assumed to be primarily step-parent adoptions, were excluded from the NSAP.

Additional details about both surveys can be found in the Appendix to this Chartbook.

i Estimate based on weighted data from the NSAP. This estimate excludes children in informal adoptions (i.e., without legally finalized adoptions)

as well as those living with at least one biological parent, most of whom are living in step families. Further information about the population of

adopted children represented by the NSAP is available in the technical appendix.
2

THREE PRIMARY WAYS TO ADOPT IN THE UNITED STATES

Foster care adoption: Children adopted from foster care are those who, prior to their adoption, were

involved with the child protective services system and removed from their families due to their families’

inability or unwillingness to provide appropriate care. Public child welfare agencies oversee such adoptions,

although they may contract with private adoption agencies to perform some adoption functions.

Private domestic adoption: This group is defined here as children who were adopted privately from within

the United States, and who were not part of the foster care system at any time prior to their adoption. Such

adoptions may be arranged independently or through private adoption agencies.

International adoption: This group includes children who originated from countries other than the United

States. Typically, adoptive parents work with private U.S. adoption agencies, which coordinate with adoption

agencies and other entities in children’s countries of origin.

Note: Additional details about how the three types of adoption were identified can be found in the Appendix to this Chartbook.

Definitions of additional terms specific to adoption can be found in the glossary at the end of this introduction.

experiences such as having a judge legally

establish the adoptive placement. Adoption is a

complex process—in terms of the paths through

which children come to be adopted, the various

processes by which parents can adopt, and the

laws that govern those processes. 

Prior to adopting, prospective adoptive parents

undergo an assessment, often called a home

study. The purpose of this assessment is to

identify families’ appropriateness and readiness

for adoption. Specific requirements vary across

jurisdictions and depend upon the type of

adoption, but often involve training, individual

and family interviews, home safety inspections,

and reviews of records (such as health evaluations, child abuse and criminal clearances, 

and driving records).1

(Note to reader: Footnotes are denoted using roman numerals,

renumbered in each section of the chartbook. Endnotes are

denoted using cardinal numbers running consecutively 

throughout the chartbook.) 

Several distinct situations underlie adoption.

Children in foster care in the United States—

that is, children under the legal guardianship 

of a public child welfare agency following

maltreatment or abandonment by their birth

parents—can be adopted if reunification with

their birth parents is not in the child’s best

interests. Public child welfare agencies oversee

adoptions of foster children, either directly or

through contracts with private licensed agencies.

Other U.S. children are adopted after their

parents voluntarily make an adoption plan 

for their child.2 Prospective adoptive parents

seeking to adopt domestically from sources

other than foster care can either use a licensed

agency or adopt independently. In a licensed

agency adoption, agencies work with both

prospective adoptive and birth families, and

often facilitate matches between them. Prior to

adoption finalization, birth parents relinquish

their parental rights to the adoption agency.

Licensed agencies must adhere to licensing and

procedural standards; unlicensed agencies are

sometimes used as well. With independent

adoption, prospective adoptive parents and

birth parents identify each other independently

of an agency, for example, through relatives 

or mutual acquaintances, word of mouth, 

or through advertisements. Attorneys may 

facilitate such adoptions.3

Americans can also adopt children from other

countries. The eligibility of these children for

adoption is governed by the laws of children’s

home countries. Following the adoption,

children must legally immigrate to the United

States (unless the parents choose to live

elsewhere). Internationally adopted children

subsequently need to be naturalized in order 

to become American citizens.

As of April 1, 2008, the Hague Convention 

on Protection of Children and Co-operation 

in Respect of Intercountry Adoption governs

adoptions from approximately 75 countries 

that, like the United States, are parties to it. The

Hague Convention determines which children

are eligible for adoption and immigration. Its

purpose is to protect children and to ensure that
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 3

placements made are in the best interests of

children. For adoptions from countries not party

to the Hague Convention, U.S. law dictates that

children must have been orphans in order 

to immigrate into the United States. U.S. law

defines an orphan as a child who has no living

parents or a child whose single parent cannot

care for the child and has provided written

relinquishment of the child for emigration 

and adoption.4

In some instances, adoptive parents and children

choose to end the relationship with the child

and do not proceed with finalization, i.e.,

legalization of an adoption, following the 

child’s placement in their home. This scenario

is referred to as “disruption.” Legally ending 

an adoption following finalization is referred 

to as “dissolution.” Dissolution is particularly

difficult to study, but existing research suggests

that it is rare.5 Children in these situations enter

(or return to) foster care or are placed with new

adoptive parents. The NSAP does not include

information on the incidence of disruption or

dissolution. The sample only includes children

with finalized adoptions living with their parents

at the time of the survey. The survey did ask

parents if they had ever considered dissolving

the adoption and positive responses were so 

rare that a reliable percentage estimate could

not be generated.

Among all adopted children in 2007—with 

the exclusion of those living with at least one

biological parent (i.e., in step families)—one out

of four was adopted from other nations; of the

remaining children adopted domestically, half

were adopted from foster care and half from

private sources; see Figure 1. For more information see Appendix Table 1 on page 53.

INTERPRETING DIFFERENCES 

AMONG PERCENTAGES

When comparing adopted children with all U.S.

children, readers should be aware of some key

differences between the two populations.

• Adopted children tend to be older than 

children in the general population. Among 

adopted children, 6 percent are under 

age 3, compared with 16 percent of 

children in the general population, 

according to data from the NSAP and 

NSCH. Among other reasons, this age 

difference is partly due to the fact that 

children are often adopted later than 

infancy. Additionally, the estimates 

presented here represent children with 

finalized adoptions, and finalizations 

typically take a minimum of six months. 

• Many child and family well-being 

indicators differ according to children’s 

ages. Therefore, when comparing wellbeing between adopted children and 

the general population of children, some 

differences may be attributable to the 

older ages, on average, of adopted 

children. For example, older children 

will have had more time in which a 

health problem may have been diagnosed 

than will younger children. As a way of 

accounting for the fact that on average 

adopted children are older, the Chartbook

presents some indicators by age group.ii

Adopted children and children in the general

population also differ in ways other than age,

some of which are explored in Part 1 of this

Chartbook. Part 1 also explores some of the 

ways in which the characteristics of adopted

children differ by adoption type.

International

25%

444,000 Foster care

37%

661,000

Private domestic

38%

677,000

 

 

 

 

 

 

 

 

Figure 1. Number and percentage 

distribution of adopted children by 

adoption type

ii The age distributions of adopted children also vary by adoption type, but in many cases, sample sizes became too small to yield reliable estimates

for age subgroups separately by adoption type.
4 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

This Chartbook provides a snapshot at a single

point in time of the characteristics, experiences,

and well-being of adopted children and their

families. All comparisons between groups 

that are highlighted in the text are statistically

significant at the .05 level of significance;

notable differences or associations that are

statistically significant at the .10 level were 

also in some cases mentioned and footnoted 

as “marginally significant” at the .10 level. 

A difference that is statistically significant is 

one that exists not just among the survey

respondents, but that can be inferred to exist 

in the population they represent; the values of

.05 and .10 are commonly used as thresholds 

for making such assumptions. Although group

differences are present by adoptive status or by

adoption type, assumptions about the reasons

for any such differences should not be made

based on the data presented in the Chartbook.

Further analyses of the data will help shed light

on how different factors are independently

associated with indicators of interest. However,

inferences concerning cause and effect are not

appropriate, even where analyses account for

multiple, interrelated variables.

In addition to testing the statistical significance

of differences between groups of children

according to adoption type, we also examined

the relative standard error of each estimate. 

The relative standard error (calculated as the

ratio of the standard error to the percentage

estimate itself) is one method for determining

the reliability of estimates. We generally 

avoided reporting estimates for which the

relative standard error exceeded 0.3, and—

at a minimum—flagged such estimates in the

appendix tables to denote their imprecision.

Additionally, value labels for percentages with

standard errors exceeding 0.3 are omitted from

the figures in this Chartbook.

CHANGES IN THE ADOPTION

LANDSCAPE

The adoption landscape is constantly shifting, as 

a result of changes in U.S. and international laws,

as well as changes in societal attitudes and other

circumstances. These changes mean that readers

should be particularly cautious in inferring how the

snapshot presented in this Chartbook may apply to

future adopted children and their families.

The Hague Convention, in particular, may result

in substantial changes to international adoption.

For example, according to the NSAP, 11 percent

of all internationally adopted children under 

age 18 had been adopted from Guatemala as of

2007, but in March 2008, the U.S. Department 

of State announced that it would not process

Guatemalan adoptions until further notice, due

to concerns about the country’s ability to adhere

to the guidelines of the Hague Convention.

Additionally, in September of 2008, Guatemala

stopped accepting any new adoption cases.

Adoptions from Guatemala came to a halt

immediately following a year during which 

it was the source of the single largest number 

of internationally adopted children.6

Even prior to the adoption of the Hague Convention, some other countries had changed their

adoption requirements. For example, as of May

2007, China enacted a stricter policy requiring 

that adoptive parents be married couples

between the ages of 30 and 50 with assets of 

at least $80,000 who are good health (including

not being overweight).7 In addition to China,

other countries, such as Russia8 and Korea,9

are attempting to promote domestic adoption

rather than relying on international adoption.

Such efforts are likely to reduce the number of

international adoptions to the United States. 

Overall, international adoptions to the United

States have been declining since 2004,10 which

may result in more parents adopting children

domestically. Beginning in the 1990s, state,

federal, and private initiatives to achieve

permanency for foster children have influenced

adoptions within the United States, as well.11

In particular, recent efforts have focused on

adoptions for older foster youth who cannot 

be reunified with their birth family. 

Recent and continuing developments in

reproductive medicine may also affect the

adoption landscape. For many people seeking 
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 5

to build families, treatments such as intrauterine

insemination and in vitro fertilization, either

with the parents’ own genetic material or with

donor sperm and/or eggs, increasingly provide

alternatives to adoption. At the same time, the

relinquishment of infants born to never-married

women has become rarer, declining from 8.7 percent

prior to 1973 to 1 percent throughout the 1990s.12

ALL ADOPTED CHILDREN

Throughout this Chartbook, we present

indicators pertaining to the characteristics,

experiences, and well-being of adopted children

and their families. We highlight a few key

findings pertaining to adopted children as 

a group below:

• Most adopted children (85 percent) are in 

excellent or very good health. At the same 

time, the parents of 26 percent of adopted 

children report that their child experiences 

moderate or severe consequences of any 

of 16 possible medical or psychological 

conditions. Adopted children are more 

likely than children in the general 

population to have health insurance 

(95 compared with 91 percent) and to 

have had insurance continuously over the 

previous 12 months (91 compared with 85 

percent). The incidence of special health 

care needs13 is about twice as high in the 

population of adopted children as it is 

among the general population of U.S. 

children (39 compared with 19 percent). 

However, because adopted children 

comprise such a small share of the general 

population, the absolute number of 

adopted children with special health care 

needs is far smaller (702,000, compared 

with 14,136,000 of all U.S. children).

• The majority of adopted children also fare 

well according to measures of social and 

emotional well-being. For example, only 

a small minority of adopted children have 

ever been diagnosed with disorders such 

as attachment disorder, depression, 

attention deficit disorder or attention 

deficit/hyperactivity disorder(ADD/ADHD), 

or behavior or conduct disorder. 

(See page 27 for definitions and the 

prevalence of these disorders.) Furthermore, 88 percent of adopted children 

ages 6 and older exhibit positive social 

behaviors. However, compared to the 

general population of children, adopted 

children are more likely to have ever been 

diagnosed with—and to have moderate 

or severe symptoms of—depression, 

ADD/ADHD, or behavior/conduct disorder.iii

• The majority of adopted children have 

enriching experiences in their families, 

and they are more likely to have some 

of these positive experiences than children 

in the general population. For example, 

they are more likely to be read to every 

day as young children (68 compared with 

48 percent in the general population), 

sung to or told stories every day as young 

children (73 compared with 59 percent), 

or to participate in extracurricular activities as school-age children (85 compared 

with 81 percent). However, a minority of 

adopted children have parents who report 

parental aggravation (for example, feeling 

the child was difficult to care for, or 

feeling angry with the child). Parental 

aggravation is more common among 

parents of adopted children than among 

parents in the general U.S. population 

(11 compared with 6 percent). 

• Overall, 87 percent of adopted children 

have parents who said they would 

“definitely” make the same decision to 

adopt their child, knowing everything 

then that they now know about their 

child. In addition, more than nine out 

of ten adopted children ages 5 and older 

have parents who perceived their child’s 

feelings towards the adoption as 

“positive” or “mostly positive.” 

• Overall, four out of ten adopted children 

are in transracial adoptions—that is, their 

parents reported that both adoptive 

iiiThe difference between the percentages of all children and of adopted children who have moderate or severe depression is marginally

significant (p<.10).
6 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

parents are (or the single adoptive parent 

is) of a different race, culture, or ethnicity 

than their child. The majority of adopted

children have non-Hispanic white parents 

but are not themselves non-Hispanic 

white. Transracial adoptions are most 

common for children whose families 

adopted internationally.

CHILDREN ADOPTED FROM 

FOSTER CARE

Children adopted from foster care are those

who, prior to their adoption, were involved with

the child protective services system and removed

from their families due to their families’ inability

or unwillingness to provide appropriate care.

Children adopted from foster care may be a

vulnerable group for several reasons. Most

children who enter foster care do so because 

of abuse or neglect by their caregivers. Once 

in foster care, lack of continued connections 

to birth parents and/or siblings, adjustments 

to cultural changes, and multiple placement

moves prior to adoption may exacerbate these

children’s existing problems or become the

causes of new ones.14 Children adopted from

foster care have had varied experiences prior 

to their adoption, and some children who had

very negative experiences still manage to thrive.

Yet, as a group, the pre-adoptive experiences 

of children adopted from foster care—many of

whom are adopted at older ages than children

adopted from other domestic sources or

internationally—are likely to make them more

vulnerable than other adopted children. 

According to the Administration for Children

and Families’ analysis of data from the Adoption

and Foster Care Reporting and Analysis System,

the number of adoptions from foster care has

ranged from 51,000 to 53,000 annually between

2002 and 2007.15 Data from the NSAP indicate

that as of 2007: (See Appendix Table 1 page 56.)

• About 661,000 children were adopted 

from foster care, representing 37 percent 

of all adopted children. Of these,

• 153,000, or 23 percent, were adopted 

by relatives.

• 262,000, or 40 percent, were adopted by 

someone who knew them prior to the 

adoption (including relatives).

• 454,000, or 69 percent, were adopted 

by someone who was previously their 

foster parent.

• 355,000, or 54 percent, have special health 

care needs.

For as many as four out of ten children adopted

from foster care, their adoptive family was their

only foster placement.iv Children adopted from

foster care are more likely than other adopted

children to live in families with lower household

incomes, but their adoption-related expenses 

are considerably lower, and most are supported

through adoption subsidies. 

CHILDREN ADOPTED

DOMESTICALLY FROM SOURCES

OTHER THAN FOSTER CARE

This group includes children who were adopted

from within the United States but who were not

part of the foster care system at any time prior

to the adoption. Some of these children may

have deceased birth parents, or their birth

parents voluntarily relinquished their rights 

and chose to make an adoption plan for them.

These adoptions may be facilitated by a private

adoption agency, or they may be arranged

independently without an agency’s involvement.

Though this type of adoption is often referred 

to as private domestic adoption, for the

purposes of the survey, this group largely

excludes adoptions from foster care that are

facilitated by private agencies.16 Reliable data 

on trends in private domestic adoption are not

available. According to the NSAP, as of 2007: 

(See Appendix Table 1 page 56.)

• About 677,000, or 38 percent of adopted 

children, were adopted privately from 

sources other than foster care. Of these,

• 276,000, or 41 percent, were adopted 

by relatives.

• 301,000, or 44 percent, were adopted by 

someone who knew them prior to the 

ivTwenty-two percent of children adopted from foster care were living with their birth family immediately prior to living with their adoptive

parents, and an additional 22 percent were placed with their adoptive families in their first month of life. These figures suggest that, for up to

45 percent of children adopted from foster care, their adoptive parents were their only foster placement. However, it is possible that some

adopted children may have lived in another foster placement, returned to their birth parents, and then moved in with their adoptive parents.
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 7

adoption (including relatives). 

• 218,000, or 32 percent, have special 

health care needs.

The majority of children adopted privately in the

United States were placed with their adoptive

family as newborns or when they were younger

than one month old (62 percent). 

CHILDREN ADOPTED FROM

INTERNATIONAL SOURCES

This group includes children adopted from

countries other than the United States. Typically,

the adoption is facilitated by a private adoption

agency. International adoptions had increased

from about 15,000 to over 22,000 children in

2004. Since 2004, international adoptions have

been steadily decreasing, to below 18,000 in

2008.17 According to the 2007 NSAP, this group is

somewhat smaller than either of the domestic

adoption groups: (See Appendix Table 1 on 

page 56.)

• Numbering at about 444,000, children 

adopted internationally comprise 25 

percent of all adopted children. Of these,

• 128,000, or 29 percent, have special 

health care needs.

As of 2007, six out of ten internationally

adopted children had been adopted from 

Asia, with over half of them (33 percent of all

international children) coming from China. In

1979, China introduced a population control

policy that generally restricted married, urban

couples to having one child. This policy, in

combination with a Chinese preference for male

children, has contributed to the large number of

girls adopted from China by American parents.18

Largely because of the high proportion of girls

adopted from China, only one out of three

internationally adopted children are male. 

Many children adopted internationally have

lived in congregate care facilities (70 percent)

prior to living with their adoptive families.

International adoption expenses are significantly

higher than those for other types of adoption,

with expenses of $20,000 or more for nearly 

half of this group of children. Correspondingly,

internationally adopted children are more likely

than other types of adopted children to live in

households with incomes over four times the

poverty threshold. 

THE CHARTBOOK

As we have described, adopted children and

their families represent a diverse population that

has followed complex pathways to adoption.

Part 1, “The Population,” presents information

regarding the demographic and socio-economic

characteristics of adopted children and families,

as well as measures of child and family wellbeing. Part 2, “The Adoption Process,” presents

information regarding parents’ motivation for

adoption, satisfaction with their agency or

attorney, openness of adoption (i.e., contact

between adopted children and birth-family

members), and post-adoption supports and

services. The Chartbook presents findings for 

the population of adopted children as a whole

and, where possible, comparable data for the

entire population of U.S. children.v To illuminate

some of the differences as well as some of the

similarities among adopted children, we also

present information separately by adoption

type—children adopted from foster care,

children adopted privately in the United 

States, and children adopted internationally.

Respondents to the NSCH were adults in the

household knowledgeable about the child’s

health, and for the NSAP were adoptive 

parents. While these interviewees have 

intimate knowledge regarding their families,

their responses were not independently 

verified and could be subject to recall errors 

or to other biases. Interested readers will find

detailed tables in the Appendix to support 

the information described throughout the

Chartbook.

v This is possible for those variables based on data from the National Survey of Children’s Health.
8 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

GLOSSARY

Agency adoption: Adoptions in which agencies work with both prospective adoptive and birth families, and often

facilitate matches between them. Adoption agencies may be licensed (adhering to licensing and approval standards

established by the state), or unlicensed.

Adoption: A process that establishes a legal parent-child relationship between a child and one or two adults who

are not the child’s biological parents.

Birth parents: A child’s biological, rather than adoptive, parents. The term “birth family” is also used to refer to

members of a child’s biological family.

Congregate care settings: Congregate care settings are a type of placement in which children may live when 

they are no longer living with their birth families, but before placement with adoptive families. They can include

residential group foster homes, residential group treatment facilities, or other settings such as juvenile detention

centers or hospitals. In some other countries, many infants and young children available for adoption live in

orphanages, whereas these children in the United States tend to live with foster families.

Disruption: An adoption that is terminated after the child has been placed with a family, but before the adoption

has been legally finalized.

Dissolution: An adoption that has been reversed; that is, an adoption that is terminated after the child has been

placed with the family and after the adoption has been legally finalized.

Finalization: The legal act of establishing an adoption.

Foster care: Children under the legal guardianship of a public child welfare agency following maltreatment or

abandonment by their birth parents are in foster care. Typically, they are cared for either by foster families who 

may or may not be related to them, or in congregate care settings.

Home study: An assessment of prospective adoptive parents intended to identify families’ appropriateness and

readiness for adoption. The specific legal requirements for home studies vary across jurisdictions and depend upon

the type of adoption.

Independent adoption: Prospective adoptive parents and birth parents identify each other independently of 

an agency, for example, through relatives or mutual acquaintances, word of mouth, or through advertisements.

Attorneys may facilitate such adoptions.

Match: A match occurs when an agency identifies and approves a plan for specific adults to adopt a specific child 

or children. In international adoption, this is sometimes called a “referral,” from the adoptive parents’ point of view.

Permanency: Permanency refers to a living arrangement that is intended to be permanent, rather than temporary,

for example, adoption and reunification. Because foster care is intended to be temporary, caseworkers establish and

work toward “permanency goals” for children in foster care.

Placement: The setting in which a foster child or adopted child lives. When the Chartbook refers to the placement 

of adopted children with their parents, it refers to the time at which children began living with their adoptive

parents, which often occurs before the legal finalization of the adoption.

Pre-adoptive placement: A child who has moved in with adults who plan to adopt that child is said to be in a 

“pre-adoptive placement” until the adoption is finalized.

Reunification: The return of a foster child to live with the parent(s) from whom he or she was removed. 

Transracial adoption: In this Chartbook, we define transracial adoptions as those in which parents reported that 

they (including both parents, for children living with two parents) are of a different race, culture, or ethnicity than 

their child.
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 9

Part 1:

The Population

Part 1 presents some key population

characteristics of adopted children and their

families. Information presented includes children’s

prior relationship to their parents, socio-economic

and demographic characteristics, and child and

family well-being. Child well-being measures

include physical health, social and emotional 

well-being, and cognitive development and

educational achievement. Parenting and 

family well-being includes findings on family 

and community activities, parent well-being,

adoption satisfaction, and parent involvement and

advocacy. Because many of the indicators in Part 1

draw heavily on data from the NSCH, we are able

to present many comparisons between adopted

children and children in the general population.

KEY FINDINGS

• More than four out of ten adopted children (43 percent) lived with their birth families at some time prior to 

their adoption. Thirty-two percent were adopted at birth or were not yet one month old when placed with 

their adoptive parents; 24 percent were adopted by relatives.

• Overall, about half of adopted children (49 percent) are male. However, 33 percent of internationally adopted 

children are male, whereas 57 percent of children adopted from foster care are male.

• The distribution of race and Hispanic origin differs between adopted children and adoptive parents. A minority 

of adopted children are non-Hispanic white (37 percent), compared with a majority of children’s parents (73 

percent). Overall, 40 percent of adopted children are of a different race, culture, or ethnicity than both of their 

adoptive parents (or their sole parent if there is only one parent in the household).

• Adopted children tend to be somewhat older than children in the general population. For example, 14 percent 

of adopted children are under 5 years old, compared with 27 percent of children in the general population.

• Adopted children are less likely than are children in the general population to live in households with incomes 

below the poverty threshold (12 compared with 18 percent). However, nearly half (46 percent) of children 

adopted from foster care live in households with incomes no higher than two times the poverty threshold.

• Over two-thirds of adopted children—69 percent—live with two married parents, and they are just as likely to 

do so as children in the general population. 
10 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

• Like children in the general population, most adopted children are in excellent or very good health (85 percent).

However, while a minority of adopted children have special health care needs (39 percent) or moderate or 

severe health difficulties (26 percent), or have ever been diagnosed with asthma (19 percent), they are more 

likely to have experienced these health issues than are children in the general population (19 percent, 10 

percent and 13 percent, respectively). However, the majority of adopted children have adequate health 

insurance (78 percent) and have been consistently insured over the prior 12 months (91 percent).

• The majority of adopted children fare well on six measures of socio-emotional well-being. For example, only 

a small minority of adopted children have ever been diagnosed with disorders such as attachment disorder, 

depression, attention deficit disorder or attention deficit/hyperactivity disorder, or behavior or conduct disorder. 

Furthermore, 88 percent of adopted children ages 6 and older exhibit positive social behaviors. However, 

adopted children tend to have somewhat lower levels of socio-emotional well-being across a variety of 

measures, compared with children in the general population. See Appendix Table 8 on page 66 for 

specific figures. 

• More than half of school-age adopted children have excellent or very good performance in reading and 

language arts and the same is true for math, according to their parents. Furthermore, 69 percent are 

engaged in school (i.e., they care about doing well in school and regularly do homework), but they are 

somewhat less likely to be engaged in school than are children in the general population (81 percent).

• The majority of adopted children have enriching experiences in their families, and they are more likely to have 

certain of these positive experiences than are children in the general population. For example, they are more 

likely to be read to every day as young children (68 compared with 48 percent), to be sung to or told stories 

every day as young children (73 compared with 59 percent), or to participate in extracurricular activities as 

school-age children (85 compared with 81 percent).

• Overall, 81 percent of adopted children have parents who reported their relationship with their child as very 

warm and close. In addition, 42 percent had parents report the relationship as “better than ever expected,” 

with only 15 percent reporting the relationship as “more difficult” than they ever expected.
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 11

In this section, the Chartbook reports on

whether or not adopted children had ever 

lived with their birth family and where they

lived immediately prior to living with their

adoptive parents. It also includes information 

on children’s relationships to their parents prior

to the adoption. (Prior relationships could

include that they were already related to the

child, that they had known the child previously,

and—for adoptions from foster care—that they

were foster parents to the child.) See Appendix

Table 2 on page 58 for detailed data on each

indicator.

Forty-three percent of adopted children lived

with their birth families at some time prior to

their adoption; see Figure 2. Of these, about 

half lived with their birth families immediately

before the adoptive placement (22 percent of 

all adopted children). The proportion of children

who have ever lived with their birth families

varies across adoption types; it is highest for

those adopted from foster care (59 percent) and

lowest for children adopted internationally (25

percent). For children adopted by relatives, these

figures are considerably higher. Seventy-three

percent of children adopted by relatives had

ever lived with their birth family. In contrast,

among children adopted by non-relatives, 53

percent of those adopted from foster care ever

lived with their birth family, as did 17 percent of

those adopted privately from the United States;

see Figure 3.

Children’s pre-adoptive placement differs

depending on adoption type. The majority of

children adopted privately in the United States

were placed with their adoptive family as

newborns or when they were younger than 

one month old (62 percent). In contrast, children

adopted internationally overwhelming lived in

congregate care facilities prior to the adoptive

placement (70 percent) or with a foster family

(24 percent). Seventy-eight percent of children

adopted from foster care lived with a foster

family or in some other foster care setting away

from their birth family prior to their adoptive

placement. Among children adopted from foster

care, 44 percent lived with a foster family other

than their adoptive family immediately prior to

their adoptive placement, and 11 percent lived

in congregate care.

For many children adopted from foster care,

their adoptive family was likely their only foster

43%

59%

39%

25%

All adopted

children

Private International

domestic

Foster

care

Adoption Type

Percent

 

 

0

10

20

30

40

50

60

70

80

90

100

Figure 3. Percentage of children 

adopted from foster care and from other

domestic sources who have ever lived 

with birth family members, by 

pre-adoptive relationship to parents

73%

33%

53%

17%

Foster care Private domestic

Relative adoptions

Non-relative adoptions

Percent

Note: Percentages for all adopted children include children adopted 

internationally, the vast majority of whom were adopted by non-relatives. 

78%

71%

All adopted children 

0

10

20

30

40

50

60

70

80

90

100

Children’s history, prior

relationship with parents

Figure 2. Percentage of adopted 

children who have ever lived with birth

family members, by adoption type
12 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

placement. Although more than half of children

adopted from foster care were living with

another foster family or in congregate care prior

to living with their adoptive families, a substantial proportion were not previously in foster

care settings. Specifically, 22 percent lived with

their birth family, and an additional 22 percent

were placed with their adoptive families in their

first month of life. These figures suggest that for

more than four out of ten children adopted

from foster care, their adoptive parents may

have been their only foster placement setting.

Among children adopted from foster care 

and from other domestic sources, adoption by

relatives or by adults who knew the child prior 

to the adoptive match is common. More than 

two out of ten children adopted from foster 

care (23 percent) were adopted by relatives, and

an additional 22 percent were adopted by nonrelatives who knew the child prior to the adoptive

match. For other domestic adoptions, relative

adoption is even more common. Of privately

adopted U.S. children, 41 percent were adopted

by relatives and an additional 7 percent were

adopted by non-relatives who previously knew

the child. Reports of internationally adopted

children adopted by relatives were too rare to

yield a reliable percentage estimate. 

ADOPTION TERMINOLOGY

Placement: The setting in which a foster child or adopted child lives. When the Chartbook refers to the placement

of adopted children with their parents, it refers to the time at which children began living with their adoptive

parents, which often occurs before the legal finalization of the adoption.

Congregate care: Congregate care settings include residential group foster homes, orphanages, residential group

treatment facilities, or other settings such as juvenile detention centers or hospitals. Children no longer living with

their birth families may reside in congregate care prior to adoption. In some other countries, many infants and young

children available for adoption live in orphanages, whereas children waiting for adoption in the United States tend

to live with foster families.

Foster family: A family (who may or may not be related to the child) who provides care during the time in which

the child is under the legal guardianship of a public child welfare agency.

Birth parents: A child’s biological parents. The term “birth family” is also used to refer to members of a child’s biological

family, or individuals related by marriage to the child’s biological family (for example, step-siblings and aunts and uncles).

Adoptive match: A match occurs when an agency identifies and approves a plan for specific adults to adopt a

specific child or children. In international adoption, this is sometimes called a “referral.”

MEASURES RELATED TO CHILDREN’S HISTORY AND 

PRIOR RELATIONSHIP TO THEIR PARENTS

Ever lived with birth family: Parents reported whether their child “has...ever lived with his/her birth family.”

Where child lived before living with parent: Parents were asked, “Just before being placed with you, where did

[your child] live?” We identified several types of placements, including 1) birth parent(s) or birth family members

other than parents, 2) a foster family, and 3) congregate care. Congregate care includes group homes in the U.S.

foster care system (that is, a group home with four foster children or more), residential treatment facilities in the

U.S. (that is, a facility where large numbers of children and youth live), institutions or orphanages, or hospitals or

health clinics. Additionally, we reported a fourth category that includes children who had been adopted at birth 

or placed with the adoptive parents prior to one month of age. In some of these cases, parents said children lived

at a hospital prior to their adoptive placement; due to their young age, we assumed such hospital stays were

related to the births. Finally, we grouped all other children, including those whose parents reported that their prior

placement had been another adoptive family, or someplace else not mentioned, into a separate “other” category.

Parent and child were relatives prior to adoption: For this item, parents reported whether they or their spouse

or partner were previously related to their child, for example, as a grandparent, aunt, or uncle.

Parent and child knew each other prior to adoption: Parents also reported whether they or their spouse or partner

knew their child before they considered adopting him or her, or before being matched with the child for adoption.

Parent was a foster parent to the child: We defined parents as having previously been foster parents to their

child if they reported either that they or their spouse or partner had been the child’s foster parent at any time before

the adoption was finalized, or at the time they began the adoption process.
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 13

This section reports on demographic indicators

related to race, ethnicity, and gender for adopted

children and their parents. These include the race

and Hispanic origin of adopted children and of

their parents, transracial adoption (that is, adoptions

in which the race, ethnicity, or culture of origin

differs for adopted children and their parents), and

the child’s gender. Additionally, for internationally

adopted children, we report on children’s region

and country of origin. See Appendix Table 3 on

page 59 for detailed data on each indicator.

The race and ethnic distribution of adopted

children is different from that of children in the

general population. Adopted children are less

likely to be white or of Hispanic origin than

children in the general U.S. population, and they

are more likely to be black;i see Figure 4. The racial

distribution of children also varies by type of

adoption, with children adopted from foster care

most likely to be black (35 percent) and those

adopted internationally least likely to be black 

(3 percent). Children adopted privately from the

United States are most likely to be white (50

percent); those adopted internationally are least

likely to be white (19 percent). The majority of

children adopted internationally are Asian (59

percent). In comparison, very few children adopted

from foster care or through private domestic

adoptions are Asian; in fact, the proportion 

is so small that reliable estimates could not be

generated. The percentage of adopted children

who are Hispanic does not vary by type of

adoption; see Figure 5.

The race and ethnic distribution of adopted

children is different from that of adoptive parents.

Whereas a majority of adopted children are nonwhite, the majority of these children’s parents 

are white (73 percent). Sixty-three percent of

children adopted from foster care have white

parents, as do 71 percent of children adopted

within the United States, and 92 percent of

children adopted internationally.ii A substantial

portion of adopted children have black parents,

including 27 percent of children adopted from

foster care and 19 percent of those adopted

privately within the United States; see Figure 6.

Given that the racial and ethnic distribution 

of adopted children differs from that of their

parents, it is not surprising that four out of ten

children have parents who report that they and

their spouse or partner (if they have one) are of 

a different race, ethnicity, or culture than their

child. Children adopted internationally are most

likely to be in transracial placements (84 percent),

compared with 28 percent of children adopted

from foster care and 21 percent of those adopted

privately from within the United States; see 

Figure 7.

Figure 4. Percentage distribution of all children and adopted children by 

race and Hispanic origin

All children

Hispanic

20%

NonHispanic

white 

56%

Other nonHispanic 

6%

NonHispanic 

black 

14%

Non-Hispanic 

Asian

4%

Adopted children

Hispanic

15%

NonHispanic

white 

37%

NonHispanic

black 

23%

Other 

non-Hispanic 

9%

Non-Hispanic

Asian 

15%

Race, ethnicity, and gender

i All analyses pertaining to race and Hispanic origin examined mutually exclusive groupings. In other words, the racial categories white, black,

Asian, and other exclude individuals who are non-Hispanic. Those identified as Hispanic may be of any race.

ii The difference between the percentages of adopted children who have non-Hispanic white parents is marginally significant for children

adopted from foster care compared with those adopted privately from the United States (63 compared with 71 percent, respectively; p<.10).
14 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

Children’s gender distribution varies substantially

by adoption type. Overall, about half of adopted

children are male (49 percent), but gender

distribution varies by adoption type. Only onethird of children adopted internationally are male

(33 percent) compared with a slight majority of

children adopted from foster care and through

private domestic adoptions (57 and 51 percent,

respectively). Among internationally adopted

children, only 19 percent of Asian children are

male, reflecting the large number of girls 

adopted from China.

Among internationally adopted children, more

than twice as many were born in China as in any

other individual country. Specifically, 33 percent 

of internationally adopted children lived in China

prior to their adoption; the second-most common

country of origin is Russia, with 13 percent. Eleven

percent of the internationally adopted children

originate from Guatemala, and another 11 percent

originate from South Korea. Other countries from

which internationally adopted children originate

include India, Kazakhstan, Colombia, Ukraine,

Philippines, and Ethiopia. All had too few children

to generate reliable estimates of their frequency.

Figure 6. Percentage distribution of

adopted children by race and Hispanic 

origin of their parents, by adoption type

Foster care Private domestic International

63%

Non-Hispanic white

Non-Hispanic black

Hispanic origin

71%

19%

27%

5% 7%

92%

Percent

 

 

 

 

 

 

 Note: Values corresponding to unreliable percentage estimates 

have been suppressed in this figure.

0

10

20

30

40

50

60

70

80

90

100

Figure 7. Percentage of adopted children

who were adopted transracially, by 

adoption type

40%

28%

21%

84%

All adopted

children

Private International

domestic

Foster

care

Adoption Type

Percent

0

10

20

30

40

50

60

70

80

90

100

Figure 5. Percentage distribution of 

adopted children by race and Hispanic 

origin, by adoption type

Percent

37% 35%

16%

59%

17%

3%

25%

13%

19%

50%

Note: Values corresponding to unreliable percentage estimates 

have been suppressed in this figure.

 

 

 

 

Non-Hispanic white

Non-Hispanic black

Hispanic origin

Non-Hispanic Asian

Foster care Private domestic International

0

10

20

30

40

50

60

70

80

90

100

MEASURES PERTAINING TO CHILDREN’S

RACE, ETHNICITY, AND GENDER

Children’s race and Hispanic origin

Parents’ race and Hispanic origin

Child gender

Transracial adoption: We categorized children as having

been transracially adopted if their parents reported that

their child was “of a different race or ethnicity or from 

a different culture” compared to themselves and their

spouse or partner (if they had one).

Region of origin: Regions from which internationally

adopted children came include Asia, Europe, South

America, North America, and Africa. Other regions had

too few adoptions to be reported separately.

Country of origin: Countries from which internationally

adopted children most commonly originated include China,

Russia, Guatemala, and South Korea. We grouped together

the fifth through tenth most common countries of origin,

including India, Kazakhstan, Colombia, Ukraine, Philippines,

and Ethiopia. Other counties had fewer adoptions to the

United States, so reliable estimates could not be calculated.
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 15

In this section we examine additional demographic and socio-economic characteristics. The

indicators here include children’s current ages,

whether children’s parents have a spouse or

partner, parents’ current ages, the age gap

between parent (or spouse/partner of parent,

whichever is smaller) and child, the education of

the parent with the highest level of educational

attainment, household income-to-poverty ratio,

and parental employment. See Appendix Table 4

on page 60 for detailed data on each indicator.

Adopted children tend to be older than children

in the general population. Among adopted

children, 6 percent are under age 3 compared

with 16 percent of children in the general

population; see Figure 8. Among other reasons,

this age difference is due to the fact that some

children are adopted at older ages, rather than

as infants. Additionally, the estimates presented

here are representative of children with

finalized adoptions, and adoptions typically take

a minimum of six months to finalize. Larger

percentages of internationally adopted children

are under age 5 (24 percent) than are other

adopted children (9 percent for children

adopted from foster care; 13 percent for those

adopted privately from the United States).i

Adopted children are less likely than children 

in the general population to live in families 

with incomes below the poverty threshold, 

and they are more likely to have a parent who

has completed education beyond high school.

However, these characteristics vary substantially

by adoption type. Specifically, internationally

adopted children are more likely than children

adopted from foster care or from other domestic

sources to have a parent with education beyond

high school (95 percent compared with 70 and

79 percent, respectively), and to have incomes

exceeding four times the federal poverty threshold (58 percent compared with 25 and 33

percent, respectively).19 Internationally adopted

children are also more likely than other 

adopted children to live in households in which

both or the single parent works full time (43

percent compared with 31 percent of children

adopted from foster care or from other domestic

sources); see Figure 9. Children adopted privately

from the United States are the most likely to

have retired parents (15 percent), followed by

children adopted from foster care (6 percent). 

Other demographic and

socio-economic characteristics

i The difference between the percentages of internationally adopted children and privately adopted U.S. children that are under age 3 (6

compared with 10 percent, respectively) is marginally significant (p < .10).

Figure 8. Percentage distribution 

of all children and adopted children 

by child age

All children

Adopted children

Age 15-17

17%

Age 5-9

27%

Age 10-12

17%

Age 0-2

16%

Age 13-14

12%

Age 3-4

11%

Age 15-17

23%

Age 5-9

30%

Age 10-12

19%

Age 

0-2

6%

Age 13-14

14%

Age 3-4

9%
16 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

MEASURES OF OTHER DEMOGRAPHIC AND SOCIO-ECONOMIC CHARACTERISTICS

Child’s current age: Parents reported children’s ages, and had the option to do so in months as well as years

(primarily for infants under one year old).

Parent’s current age: Parents reported the year in which they were born. To generate an estimate of their

age we subtracted the year of birth from 2007, the year during which most of the NSAP interviews took place.

Age gap between parent (or spouse/partner of parent) and child: We calculated the difference in ages

between the adopted child and each parent (for children who had two parents) and identified whichever

difference was smaller.

Education of parent with highest level of educational attainment: We compared the educational

attainment of the child’s parent and the parent’s spouse/partner (if there was one) and reported whichever 

was higher. Categories include less than high school diploma, 12 years (or high school diploma or general

equivalency degree), or more than 12 years.

Household income-to-poverty ratio: Parents reported their total combined family income during the prior

calendar year for all members of the family, before taxes. The amount was then compared with the federal

poverty threshold, as established by the U.S. Department of Health and Human Services (http://aspe.hhs.gov/poverty).

Parental employment: Parents answered the question, “Last week were you working full time, working part

time, temporarily not working, unemployed, retired, going to school, keeping house, or something else?” They

also answered this question regarding their spouse or partner, if they had one. The category “parents work full

time” includes single parents who work full-time and households with two parents, both of whom work fulltime. The category “retired parents” includes single parents who are retired and households with two parents,

both of whom are retired.

Note: Appendix Table 4 also includes the age of the spouse/partner of parent for parents who are not single.

Figure 9. Percentage of adopted children by socio-economic and demographic 

characteristics, by adoption type

Percent

Parent is >=50

years older than

child

Parental education

beyond high

school

Household income

>=400% poverty

threshold

Parent(s) are 

employed 

full-time

Note: Values corresponding to unreliable percentage estimates have been suppressed in this figure.

70%

11% 13%

25%

95%

79%

58%

33% 31%

43%

31%

0

10

20

30

40

50

60

70

80

90

100

Foster care

Private domestic

International
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 17

This section describes the structural characteristics

of families in which adopted children live. Specifically, we report whether or not adopted children

have birth siblings and whether any of those children had also been adopted by the child’s parents.

In addition, parents’ marital status and whether

the parents were married at the time of the adoption, the total number of children under 18 in the

household, and the presence of birth and adopted

children are reported. See Appendix Table 5 on

page 62 for detailed data on each indicator.

Seventy-one percent of adopted children have

known birth siblings. Of these, 29 percent have

birth siblings also adopted by the adoptive

parent; see Figure 10. The percentage of all

adopted children who have birth siblings also

adopted by their parents varies across adoption

types. The percentage is higher for children

adopted from foster care (36 percent) than for

those adopted privately from other domestic

sources (15 percent) or internationally (7 percent);

see Figure 11. Knowledge of children’s birth

siblings also varies by adoption type. Parents of

internationally adopted children are less likely

than parents of children adopted from the United

States to have reported knowing of birth siblings.

Thirty-one percent of internationally adopted

children had parents who knew of birth siblings,

compared with 89 and 80 percent for foster care

and private domestic adoptions, respectively.i

Most adopted children live with two married

parents. Like children in the general U.S.

population, about seven out of ten adopted

children live in families with two married parents,

one or both of whom may be adoptive parents.

Children adopted internationally are most likely

to have two married parents (82 percent), while

children adopted through private domestic

sources are least likely (59 percent);20 see Figure

12. Thirty-nine percent of adopted children 

live with one adoptive parent in the family.21

Many adopted children are the only child in 

the household. Thirty-eight percent of adopted

children are the only child in the household under

18.ii This varies by adoption type, with privately

adopted U.S. children most likely to be the only

child in the household (48 percent, compared

with 27 and 37 percent of foster care and international adoptions, respectively). Conversely,

children adopted from foster care are the most

likely to live in households with three or more

children (40 percent, compared with 16 percent

each of children adopted privately from the

United States and internationally).

Family structure

Figure 10. Percentage distribution of

adopted children by existence of birth 

siblings; percentage distribution of

adopted children with birth siblings by

whether of not parent also adopted 

child’s birth sibling(s)

i These figures are likely underestimates of the percentages of children who actually have birth siblings, as many parents did not know whether their

children have birth siblings. 

ii Many of these children have siblings living elsewhere or with another parent or older siblings no longer living in the same household. The percentage 

of adopted children who are “only children”—that is, who have no other biological or adoptive siblings living anywhere—is smaller.

No known

birth siblings

15%

Child has birth 

siblings

71%

Parents 

didn’t know 

if child has 

birth siblings 

14%

Sibling(s) never

available for 

adoption

36%

Sibling(s) 

available for 

adoption, parent 

didn’t adopt

21%

All adopted children

Adopted children with known

birth siblings

Sibling(s) also

adopted by parent

29%

 Not known if 

sibling(s) ever 

 available for 

 adoption 

 14%
18 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

MEASURES PERTAINING TO FAMILY CHARACTERISTICS AND FAMILY STRUCTURE

Child’s birth siblings: We reported on whether or not children have biological siblings, in combination with

whether or not the children’s parents have also adopted the child’s siblings. Categories are based on parental

responses to several questions about whether the adopted child has birth siblings including half siblings,

whether those siblings were available for adoption, and whether the parent adopted the siblings. A

substantial portion—15 percent—of children have parents who said “I don’t know” in response to the

question about the existence of birth siblings. Additionally, some children whose parents responded “no” to

the question likely have birth siblings of whom their parents are not aware. Therefore, in contrast to other

measures included in this Chartbook, we included the “I don’t know” response as an explicit category for this

measure.

Parents’ marital status: We reported on the marital status of children’s parents, regardless of whether both

parents (if the child had two parents) had each adopted the child.

Family structure: We reported whether children are living with one or two adoptive parents, as well as the

marital status of those parents.

Number of children under 18 in household: We reported the number of children currently living in the

household, excluding any of the parents’ children who might have been living elsewhere.

Presence of birth and adoptive children in family: We examined whether the child was the only child in

the family, or whether the child had siblings also adopted by his or her parent and/or siblings who were

biological children to his or her parent..

36%

 

 

 

 

Percent

15%

7%

Foster care Private domestic International

0

10

20

30

40

50

60

70

80

90

100

Figure 11. Percentage of adopted 

children with birth siblings also 

adopted by parent, by adoption type

Percent

40%

21%

10%

0

10

20

30

40

50

60

70

80

90

100

Foster care Private domestic International

 

 

 

 

 

 

 

 

 

 

 

 

0

10

20

30

40

50

60

70

80

90

100

70%

59%

82%

71% 69%

Percent

All 

adopted

children

Private International

domestic

Foster

care

Adoption Type

All 

children

 

 

 

 

Figure 13. Percentage of adopted 

children whose parents have other 

adopted children and biological children

Figure 12. Percentage of children with married 

parents, by adoptive status and by adoption type

Children adopted from foster care 

tend to have more complex family

structures than children adopted from

other sources. Forty percent of children

adopted from foster care live in families

with adopted and birth children, while 

21 percent of privately adopted U.S.

children and 10 percent of internationally adopted children have this family

structure; see Figure 13. Children

adopted privately from the United States

and children adopted internationally are

more likely than children adopted from

foster care to be the only child in the

family (24 and 23 percent, respectively,

compared to 11 percent).
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 19

To provide information about the neighborhoods in which adopted children live, this section

reports on whether or not adopted children live

in or near urban areas, as well as on whether the

children’s neighborhoods are safe, have characteristics indicating poor physical condition, and

have amenities. See Appendix Table 6 on page

63 for detailed data on each indicator.

Overall, 76 percent of adopted children live in or

near urban areas, 79 percent live in safe neighborhoods, and 75 percent live in neighborhoods with

no characteristics of poor physical condition. Poor

physical neighborhood conditions include litter or

garbage, poorly kept or dilapidated housing, and

vandalism. Very few (4 percent) live in neighborhoods with no amenities. Neighborhood

amenities include sidewalks or walking paths;

parks or playground areas; recreation centers,

community centers, or boys’ or girls’ clubs; and

libraries or bookmobiles. Adopted children are

slightly more likely than children in the general

population to live in safe neighborhoods and in

neighborhoods that show no poor physical

conditions.i Adopted children and children in the

general population are equally likely to live in or

near urban areas; see Figure 14.

Internationally adopted children are slightly 

less likely than other adopted children to live 

in neighborhoods with no amenities, although

living in such neighborhoods is very rare among

all adopted children (4 percent). The likelihood

of living in a safe neighborhood or a neighborhood with no characteristics of poor physical

condition does not vary by adoption type, nor

does the percentage living in or near urban areas. 

Neighborhood characteristics

i The difference between the percentages of adopted children living in neighborhoods in good condition (75 compared with 71 percent,

respectively) is marginally significant (p < .10).

 

 

 

 

 

 

 

 

 

 

 14%

Percent

78%

Metropolitan Statistical 

Area

Neighborhood is safe

76%

71%

79%

71%

75%

95% 96%

Neighborhood has no 

characteristics of poor

physical condition

Neighborhood has any 

amenities

All children All adopted children

0

10

20

30

40

50

60

70

80

90

100

Figure 14. Percentage of children living in neighborhoods with various characteristics, 

by adoptive status
20 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

MEASURES PERTAINING TO NEIGHBORHOOD CHARACTERISTICS

Urban areas: To determine whether children live in or near an urban area, we identified whether the child’s county was

part of a Metropolitan Statistical Area (MSA). MSAs include counties containing an urban area with a population of at

least 50,000, as well as adjacent counties that are socially and economically integrated with the urban core. 22 MSA status in

the NSCH was suppressed for children living in states with either fewer than 500,000 persons living in MSAs or fewer than

500,000 persons not living in MSAs. Among these children, we assumed that children living in primarily urban states were

living in MSAs and that children living in other states were not living in MSAs.

Safe neighborhoods: To assess whether children live in safe neighborhoods, the survey asked parents five questions

about their perceptions of their neighborhood. Specifically, parents reported their level of agreement with four

statements: 1) “People in this neighborhood help each other out.” 2) “We watch out for each other’s children in this

neighborhood.” 3) “There are people I can count on in this neighborhood.” 4) “If my child were outside playing and

got hurt or scared, there are adults nearby who I trust to help my child.” Additionally, they reported how frequently

they feel their child is “safe in [their] community or neighborhood.” Negative responses to any of the questions (i.e.,

response of “somewhat” or “definitely disagree” to any of the first four questions, or responses of “never” or

“sometimes” to the fifth question) were categorized as not living in safe neighborhoods.

Neighborhoods in poor physical condition: Children were categorized as living in neighborhoods with poor

physical conditions if their parents reported that their neighborhood had “litter or garbage on the street or sidewalk,”

was “poorly kept or had rundown housing,” or had “vandalism such as broken windows or graffiti.”

Neighborhoods with no amenities: To identify whether children’s neighborhoods had any amenities, parents

were asked if “the following places and things are available to children in your neighborhood, even if [their child]

does not actually use them:” 1) “sidewalks or walking paths,” 2) “a park or playground area,” 3) “A recreation

center, community center, or boys’ or girls’ club,” or 4) “a library or bookmobile.”
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 21

This section reports on six health indicators for

adopted children, including their health status,

having special health care needs, missing school

due to illness or injury, having moderate or

severe health difficulties, having asthma, or

having been injured. It also presents four

measures pertaining to health insurance and

health care, factors that are not direct indicators

of children’s health, but that are important for

supporting their health. These include health

insurance coverage, consistency of coverage,

adequacy of insurance, and receipt of care in a

medical home. For definitions of these measures,

see the text boxes labeled “health measures” and

“health insurance and health care measures.”

Because the measures in this section are based

on parents’ responses in the National Survey of

Children’s Health, comparable data for children

in the general population are also included. See

Appendix Table 7 on page 64 for detailed data

on each indicator.

HEALTH AND WELL-BEING

The majority of adopted children fare well on six

measures of health. Specifically, 85 percent of

adopted children have parents who rated their

health as “excellent” or “very good.” Yet 39

percent of adopted children have special health

care needs—a broadly defined measure. Children

with special health care needs include 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. Problems

that were much less commonly reported than

special health care needs included more than 

10 school absences due to illness or injury,

having moderate or severe asthma, and having

been injured during the prior year.

However, some adopted children do experience

health problems. Twenty-six percent of adopted

children have a moderate or severe health problem; see Figure 15. Such problems include any

Physical health

i Specifically, analyses of the NSCH indicate that, of children in the general population who have moderate or severe problems, 61 percent are

rated as having “excellent” or “very good” health.

All children

All adopted children

Percent

Health status 

NOT “excellent” or 

“very good”

Missed > 10 school 

days due to illness/

injury (Ages 6+)

Moderate or 

severe asthma

Injured and required 

medical attention in 

past year (Ages 0-5)

Moderate or severe 

health problem(s)

15%

6% 7%

10%

26%

3% 4%

10%

14% 16%

0

10

20

30

40

50

60

70

80

90

100

Figure 15. Percentage of children according to their health status, by adoptive status
22 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

Percent

Foster care

Private domestic

International

 

19%

16%

7%

39%

21%

14%

Health status 

NOT “excellent” 

or “very good”

Moderate or 

severe health 

problem(s)

Ever 

diagnosed 

with asthma

24%

17% 14%

 

 

 

 

 

 

 

 

 

0

10

20

30

40

50

60

70

80

90

100

Figure 16. Percentage of adopted 

children according to their health 

status, by adoption type

Percent

All children

All adopted 

children

85%

91%

76% 78%

58% 60%

 

 

 

 

 

Consistently 

insured over

past 12 months

Adequate 

health

insurance

Receives care 

in a medical 

home

 

 

 

 

 

 

 

 

 

0

10

20

30

40

50

60

70

80

90

100

Figure 17. Percentage of children 

according to measures of health context

and insurance, by adoptive status

one of 16 possible conditions, such as asthma, 

a learning disability, or attention deficit disorder/

attention deficit hyperactivity disorder. Many

parents who reported such problems also rated

their child’s health status as “very good” or

“excellent.” (This occurs frequently in the

general population as well.) While this may

appear contradictory, many children identified as

having “moderate” or “severe” health problems

may have conditions that are largely controlled

with medication or other treatment. Children

with controlled conditions or who do not have

severe symptoms may be considered by their

parents as having excellent or very good health.

Some, but not all, of the six health indicators

also differ by adoption type. Children adopted

internationally are more likely (93 percent) 

to have parents who rated their health as

“excellent” or “very good” than those adopted

from foster care or privately from within the

United States (81 and 84 percent, respectively).

In addition, children adopted from foster care

are more likely than children adopted privately

from the United States or internationally to 

have a moderate or severe health problem (39

percent, compared with 21 and 14 percent,

respectively). Special health care needs are 

also more common among children adopted

from foster care (54 percent) than among 

other adopted children (32 percent of children

adopted from other domestic sources and 29

percent of children adopted internationally).

And, although children adopted from foster 

care are somewhat more likely than other

adopted children ever to have been diagnosed

with asthma (24 percent, compared with 17

percent of U.S. children adopted privately and

14 percent of children adopted internationally),

the percentage of adopted children with current

asthma symptoms that are moderate or severe

was small across all three types (6 percent or

less); see Figure 16.

HEALTH INSURANCE AND HEALTH CARE

The vast majority of adopted children not only

have insurance (95 percent), but have been

consistently covered over the prior 12 months (91

percent) and have adequate insurance (78 percent).

Additionally, 60 percent of adopted children

receive coordinated, ongoing, comprehensive 

care within a medical home;i see Figure 17.

Adopted children fare better than or as well 

children in the general population on health

insurance and health care measures. Adopted

children are more likely than children in the

general population to have health insurance 

(95 compared with 91 percent) and to have had

insurance continuously over the previous 12

months (91 compared with 85 percent). Similar

percentages of adopted children and children in
the general population have adequate health

insurance and have a medical home;iI see Figure 17.

Adequacy and consistency of health insurance

coverage is similar across adoption types.

Children adopted from foster care are as likely 

as the other two groups of adopted children 

to have any health insurance coverage and to

have adequate coverage. In addition, children

adopted from foster care are slightly more 

likely than privately adopted U.S. children to

have been consistently insured for the prior 

12 months (94 compared with 88 percent).iii

However, children adopted from foster care are

less likely than children adopted internationally

to receive coordinated, ongoing, comprehensive

care within a medical home (58 compared with

67 percent);iv see Figure 18.

The type of health insurance coverage 

varies by adoption type. Over half of children

adopted from foster care (59 percent) and 

one-third of children adopted privately from 

the United States are covered by public health

insurance. In contrast, internationally adopted

children are far more likely than children

adopted from foster care and privately adopted

U.S. children to be covered by private insurance

(92 percent, compared with 37 and 61 percent,

respectively).

Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 23

Percent

94%

88% 91%

58% 58%

67%

Foster care

Private domestic

International

 

 

 

Consistently insured over

past 12 months

Receives care 

in a medical home

0

10

20

30

40

50

60

70

80

90

100

Figure 18. Percentage of adopted children 

according to measures of health context and 

insurance, by adoption type

ii See the box labeled “Health insurance and health care measures” for the full definition of a medical home.

iii The difference between 94 and 88 percent is marginally significant (p<.10).

iv The difference between 58 and 67 percent is marginally significant (p<.10).

HEALTH MEASURES

Health status: To assess health status, we examined parents’ answers to the question, “In general, how would you

describe [your child’s] health? Would you say [his/her] health is excellent, very good, good, fair, or poor?”

Special health care needs: Children with special health care needs are those who currently experience at least one

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.

Moderate or severe health difficulties: Parents reported whether a doctor had ever told them that their child had

any one of 16 health conditions.23 Children whose parents reported at least one condition for their child that was

currently moderate or severe were categorized as having a moderate or severe health problem.

Impacted by asthma: Parents first reported whether a “doctor or health care provider has ever told” them that

their child had asthma. Parents who responded positively also reported whether the child currently still had asthma,

and, if so, whether the symptoms were “mild, moderate, or severe.” We grouped children into three categories: those

who had never been diagnosed with asthma, those with currently moderate or severe asthma symptoms, and those

with mild or non-current asthma.

Missed more than 10 school days due to illness or injury: This indicator was based on parental reports regarding

children ages 6 and older who were enrolled in school.

Injured during the prior 12 months: This measure was assessed for children ages 0 to 5 depending on parents’

reports that their child had “been injured and required medical attention.”
24 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

HEALTH INSURANCE AND HEALTH CARE MEASURES

Health insurance coverage: The NSCH first asked parents, “Does [your child] have any kind of health care

coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicaid?” 

If a respondent answered “yes,” the NSCH asked whether the child was covered by “Medicaid or the State

Children’s Health Insurance Program, S-CHIP?” We categorized children whose parents reported that their 

child was covered by Medicaid or S-CHIP as being covered by public insurance. We categorized all other 

children whose parents reported that they had health insurance as being covered by private insurance.

However, some share of children may be covered both by public and private insurance.

Consistency of coverage: We assessed whether children were consistently insured over the 12 months prior

to the survey, never insured over the year, currently insured but lacked coverage at some time during the year,

or currently uninsured but had coverage at some time during the year.

Adequate health insurance: This measure depends on parents’ responses to three questions: 1) “Does [your

child’s] health insurance offer benefits or cover services that meet (his/her) needs?” 2) “Does [your child's] health

insurance allow him/her to see the health care providers he/she needs?” And 3) “How often are [out-of-pocket]

costs reasonable?” Children were categorized as having adequate insurance if their parents responded “usually”

or “always” to each of the questions (or had no out-of-pocket costs and said usually or always to the other

questions). 

Care is received in a medical home: This measure is based on five components, each of which must have been

present in order to categorize children as receiving care in a medical home. The five components are: The child 1) has

a usual source for sick care, 2) has a personal doctor or nurse, 3) has no problems obtaining referrals when needed, 4)

receives effective care coordination (i.e., the family is very satisfied with doctors’ communication with each other and

with doctors’ communication with other programs, and the family usually or always gets sufficient help coordinating

care if needed), and 5) receives family-centered care, including at least one visit in the past year. Family-centered care

is care in which doctors usually or always spend enough time with the patient, listen carefully to complaints or

concerns, are sensitive to families’ values and customs, provide needed information, and make the family feel like 

a partner, and in which families have interpretation services available when needed.
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 25

To assess the social and emotional well-being of

adopted children, this section reports on whether

children have ever been diagnosed with any of

four psychological disorders, including attachment

disorder, depression, attention deficit disorder/

attention deficit hyperactivity disorder (ADD/

ADHD), or behavior/conduct disorder. Additionally,

we report on the percentages of children who

exhibit positive and negative social behaviors. 

See Appendix Table 8 on page 66 for detailed 

data on each indicator.

Most adopted children fare well, according to 

six measures of socio-emotional well-being, but 

a small minority experience serious problems.

Parents’ responses indicate that the majority of

adopted children have never been diagnosed with

each of the four psychological disorders included

in the survey. Twelve percent of adopted children

have ever been diagnosed with attachment

disorder. The survey did not ask about the severity

of the disorder. Most adopted children diagnosed

with attachment disorder have parents who

report a “very warm and close” relationship with

their child, although such reports are rarer than

among adopted children without attachment

disorder (64 compared with 84 percent). Overall, 

4 percent of adopted children both have been

diagnosed with attachment disorder and have 

a parent who reported the relationship as not

being very warm and close. 

The incidence of the other three disorders

examined here is lower than for attachment

disorder. Fourteen percent of adopted children

ages 6 and older have been diagnosed with

ADD/ADHD and have parents who rated the

condition as moderate or severe. Eight percent 

of adopted children ages 2 and older have

moderate or severe behavior or conduct

problems, according to their parents. Parents 

of 2 percent of adopted children report their

child has been diagnosed with depression and

currently has symptoms that are moderate or

severe. Also based on parent responses, 14

percent of adopted children have problems with

social behaviors. However, parents also reported

that 88 percent exhibit positive social behaviors. 

Compared to the general population of children,

adopted children are more likely to have ever

been diagnosed with—and to have moderate 

or severe symptoms of—depression, ADD/ADHD,

or behavior/conduct disorder.24 For example, 9

percent of adopted children ages 2 and older 

have ever been diagnosed with depression,

compared with 4 percent of children in the

general population. Additionally, 26 percent 

of adopted children ages 6 and older have ever

been diagnosed with ADD/ADHD, compared with

10 percent of children in the general population.

A similar pattern of differences emerges for

behavior/conduct disorder: 15 percent of adopted

children have ever been so diagnosed compared

with 4 percent of children in the general population. Adopted children are also somewhat

more likely than the general population of children to exhibit problems with social behaviors, and

are somewhat less likely to exhibit positive social

behaviors; see Figure 19.

Differences in social and emotional well-being 

by adoption type are apparent for five out of six

measures, with children adopted from foster care

more likely to have problems. Children adopted

from foster care are more likely than those

adopted privately from the United States or

internationally to have been diagnosed with

ADD/ADHD (38 percent compared with 19 and 17

percent, respectively), behavior/conduct problems

(25 percent compared with 11 and 7 percent), and

attachment disorder (21 percent compared with 

6 and 8 percent). Furthermore, children adopted

from foster care are more likely to have problems

with social behaviors than privately adopted U.S.

children (18 percent compared with 10 percent),

and they are somewhat less likely to exhibit

positive social behaviors (83 percent compared

with 91 percent);i see Figure 20. However,

depression is rare among all adopted children

regardless of the type of adoption. 

Social and emotional well-being

i Differences between children adopted from foster care and from other domestic sources in the percentages exhibiting negative and positive

social behaviors are marginally significant (p<.10).
26 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

 

0

10

20

30

40

50

60

70

80

90

100

Ever diagnosed

with depression

(age 2+)

Ever diagnosed 

with ADD/ADHD

(age 6+)

Problems 

with social behaviors

(ages 6+)

Ever diagnosed

with behavior

conduct problems

(age 2+)

9% 10%

26%

4%

15%

9%

14%

94%

88%

4%

Exhibits 

positive social 

behaviors

(age 6+)

Percent

 

 

 

All children

All adopted children

Figure 19. Percentage of children according to measures of social and 

emotional well-being, by adoptive status

Figure 20. Percentage of adopted children according to measures of social and 

emotional well being, by adoption type

Note: Values corresponding to unreliable percentage estimates have been suppressed in this figure.

 

 

89%

 

91%

83%

10%

18%

7%

11%

25%

17% 19%

38%

8% 6%

21%

0

10

20

30

40

50

60

70

80

90

100

Ever diagnosed

with attachment

disorder

Ever diagnosed 

with ADD/ADHD

(age 6+)

Problems 

with social behaviors

(ages 6+)

Ever diagnosed

with behavior

conduct problems

(age 2+)

Exhibits 

positive social 

behaviors

(age 6+)

Percent

Foster care

Private domestic

International

 
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 27

SOCIAL AND EMOTIONAL WELL-BEING MEASURES

For each of the first four disorders listed below, parents reported whether “a doctor or other health care

provider ever told them that the child had the condition, even if he/she does not have the condition now.” 

It is important to note that, while these represent clinical psychological problems, data are based on parents’

recollections of doctors’ diagnoses, rather than actual diagnoses or direct observation of children. With the

exception of attachment disorder, parents also reported whether children still had each condition at the time

of the survey, and, if so, whether it was mild, moderate, or severe.

Attachment disorder (or reactive attachment disorder, RAD): This is a disorder of infancy/early 

childhood that can severely harm children’s abilities to develop appropriate social relationships. Children 

may be excessively inhibited; alternatively, they may be indiscriminately sociable. By definition, it begins 

before age 5; it is associated with severe neglect of children’s basic emotional needs. If parents had not heard

of attachment disorder, we assumed children had not been diagnosed with it. This question was asked in the

NSAP, so comparable data are not available for the general child population.

Depression: Depressive disorders can include relatively brief episodes (e.g., 2 weeks) of chronically depressed

or irritable mood, changes in appetite or weight, changes in sleep patterns, and difficulty concentrating. It can

be associated with separation anxiety, problems with social interactions, academic problems, substance use, and

in serious cases, suicide. If parents were unfamiliar with depression, interviewers told them that “Depression is

an illness that involves the body, mood, and thoughts. It is marked by persistent sadness or an anxious or empty

mood. It affects how a person feels, and the way a person eats, sleeps, and functions.”

Attention deficit disorder or attention deficit hyperactivity disorder (ADD/ADHD): ADD/ADHD involves

inattention and/or hyperactivity or impulsivity that occurs more severely and frequently than in other children

of similar ages and that impairs children’s social or academic functioning. It is difficult to establish a diagnosis

prior to age 4 or 5, although it develops prior to age 7. When asked, interviewers explained that “a child with

attention deficit disorder or attention deficit hyperactivity disorder has problems paying attention or sitting

still. It may cause the child to be easily distracted.”

Behavior or conduct disorder: Children with conduct disorders repeatedly and persistently violate the basic

rights of others or social rules or norms. Children may threaten to or actually harm others, or engage in vandalism

or theft. Parents reported whether their child had ever been diagnosed with behavior or conduct disorder, such 

as oppositional defiant disorder. Interviewers could explain to parents that “oppositional defiant disorder is an

ongoing pattern of defiant and hostile behavior that interferes with a child’s life and daily activities.”

Positive social behaviors: Children are classified as exhibiting positive social behaviors if their parent

reported that their child “usually” or “always” engaged in all four of the following behaviors: “[shows] 

respect for teachers and neighbors,” “[gets] along well with other children,” “[tries] to understand other

people’s feelings,” and “[tries] to resolve conflicts with classmates, family, or friends.”

Negative social behaviors: Children are described as exhibiting negative social behaviors if their parent

reported that their child “usually” or “always” engaged in two out of the four behaviors: “[argues] too much,”

“[bullies or is] cruel or mean to others,” “[is] disobedient,” and “[is] stubborn, sullen, or irritable.”

Note: Detailed information on the symptoms of attachment disorder, depression, attention deficit disorder or attention deficit hyperactivity

disorder (ADD/ADHD), or behavior or conduct disorder are available in: American Psychiatric Association. 2000. Diagnostic and Statistical

Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association.
28 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

To assess the cognitive development and

educational achievement of children who 

were adopted, the Chartbook summarizes

parents’ reports on four measures for school-age

children: reading/language arts performance,

math performance, engagement in school, 

and whether children spend time reading for

pleasure. See Appendix Table 9 on page 68 

for detailed data on each indicator.

More than half of school-age adopted children

have excellent or very good performance in

reading and language arts; the same is true for

math. Nearly seven out of ten are engaged in

school. Furthermore, about eight out of ten

adopted children typically spend time reading

for pleasure on a daily basis. Among elementaryschool-age adopted children ages 6 to 11, 

about nine out of ten (88 percent) spent time

reading for pleasure.

For elementary-school-age children, reading 

for pleasure is equally likely among adopted

children and those in the general population.

However, older adopted children ages 12 to 

17 are somewhat less likely to have had their

parents report that the child spent any time

reading for pleasure on an average school day,

compared with those in the general population

(71 compared with 78 percent, respectively); 

see Figure 21. Additionally, adopted children 

are less likely than children in the general

population to be engaged in school (69 and 

81 percent, respectively); see Figure 22. 

Parents of children in the general population

were not asked about their children’s reading

and language arts or math performance.

Children adopted from foster care are somewhat

less likely than other adopted children to have

excellent or very good performance in reading

and language arts and in math, and they are less

likely to be engaged in school. Fifty percent of

school-age children who had been adopted from

foster care had parents who rated their reading

and language arts performance as “excellent” or

“very good.” Similarly, 41 percent had parents

who rated their math performance as “excellent”

or “very good”; see Figure 23. This pattern

generally holds true regardless of children’s

ages. Among 6- to 17-year-olds adopted from

foster care, 61 percent are engaged in school,

compared with 74 percent of those adopted

privately from the United States and 73 percent

of those adopted internationally. However,

reading for pleasure is equally likely for all three

types of adoptions among school-age children,

both for those of elementary school age (6 to 11

years) and for older children (ages 12 to 17).

Figure 21. Percentage of children 

ages 6-17 who spend any time reading 

on an average school day, by adoptive 

status and by child age

Cognitive development and

educational achievement 

 

 

 

 

 

89% 88%

78%

71%

Ages 6-11 Ages 12-17

Percent

 

 

0

10

20

30

40

50

60

70

80

90

100 All children

All adopted children
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 29

COGNITIVE DEVELOPMENT AND

EDUCATIONAL ACHIEVEMENT

MEASURES

Reading and language arts performance:

For this measure, we compared the percentage 

of children ages 5 to 17 whose parents rated

their “school performance in reading and

language arts” as “excellent” or “very good,”

rather than “good,” “fair,” or “poor.”

Math performance: For this measure, parents

of children ages 5 to 17 rated their child’s “school

performance in math.” Response options and

groupings were the same as with reading and

language arts performance.

Usually/always engaged in school: School

engagement was assessed based on parents’

responses about how frequently during the 

prior month children ages 6 to 17 “care[d] about

doing well in school” and “[did] all required

homework.” Children whose parents answered

“usually” or “always” to both questions were

classified as being engaged in school.

Reading for pleasure: For this indicator, we

identified whether parents who responded to 

the question, “On an average weekday, about

how much time does [he/she] usually spend

reading for pleasure?” reported that their 

child, age 6 to 17, spent any time reading.

0

10

20

30

40

50

60

70

80

90

100

81%

69%

61%

74% 73%

Percent

All children All adopted

children

Foster care Private 

domestic

International

Adoption type

Figure 22. Percentage of children ages 6-17 who are usually or always 

engaged in school, by adoptive status and by adoption type

Percent

Reading/language arts Math

50%

64% 63%

41%

58%

65%

0

10

20

30

40

50

60

70

80

90

100 Foster care

Private domestic

International

Figure 23. Percentage of adopted 

children ages 5-17 whose parents rated

their school performance as “excellent” 

or “very good,” by adoption type
30 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

This section examines a set of activities that 

are often inherently of value to children and

families and that are also predictive of child

well-being. For example, reading to young

children,25 as well as telling stories and singing 

to young children,26 supports children’s early

literacy development. Regularly sharing meals

supports parent-child connectedness and family

connectedness and may positively influence

adolescents’ nutrition habits and behavioral

outcomes.27 Finally, although children’s

participation in extracurricular activities takes

place outside the family, parents typically

facilitate children’s participation. Extracurricular

activities can positively influence children’s

academic performance and social skills, 

and they provide opportunities to develop

supportive relationships with caring adults.28

See Appendix Table 10 on page 69 for detailed

data on each indicator.

Overall, most adopted children have families

that engage in positive and supportive activities.

For example, almost seven out of ten adopted

children under age 6 are read to every day, and

more than seven out of ten adopted children

under age 6 are sung to or told stories every day;

see Figure 24. Over half of all adopted children

eat meals together with their families six or

seven days per week. More than eight out of ten

adopted children ages 6 through 17 participate 

in extracurricular activities; see Figure 25.

Adopted children are more likely than children

in the general population to experience each 

of the four family activities examined here.

Specifically, 68 percent of young adopted

children were read to every day during the 

prior week, compared with 48 percent in the

general population. Similarly, 73 percent of

young adopted children were sung to or told

stories every day during the prior week; this 

was true of 59 percent of all young children; 

see Figure 24. Adopted children are also 

slightly more likely than children in the general

population to eat meals with their families six or

seven days a week (56 compared with 52 percent).i

Eighty-five percent of adopted children ages 6

and older participated in an organized activity,

compared with 81 percent of all children 

ages 6 and older.ii

Results on two of the measures of family

activities differ by adoption type, with internationally adopted children most likely to

experience positive circumstances. Nearly twothirds of children adopted internationally (64

percent) eat meals with their families six or

seven days a week, compared with just over 

half of children adopted from foster care and in

private domestic adoptions (54 and 52 percent,

respectively). Additionally, children adopted

internationally are more likely to have participated in an organized activity than children

adopted from foster care or privately in the 

Unites States (93, compared with 81 and 85

percent, respectively). However, there are no

differences across adoption types for reading to

young children or in telling stories and singing

to young children. 

Family and community activities

i This difference is marginally significant (p<.10).

ii The difference in organized activity participation between adopted and all children was concentrated among 6- to 11-year-olds (89 percent

compared with 79 percent).

Percent

Child age 0-5 was 

read to every day

Child age 0-5 was

sung to or told stories 

every day

48%

68%

59%

73%

0

10

20

30

40

50

60

70

80

90

100

All children

All adopted children

Figure 24. Percentage of children whose

parents read to them and sing or tell 

stories to them, by adoptive status
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 31

Percent

0

10

20

30

40

50

60

70

80

90

100

81%

85%

81%

All children All adopted

children

Foster care Private 

domestic

International

85%

93%

Adoption type

 

 

 

 

 

 

MEASURES OF FAMILY AND COMMUNITY ACTIVITIES AND CONTEXT

Child is read to every day: This measure was assessed for children ages 0 to 5 based on parents’ answers to

the question, “During the past week, how many days did you or other family members read to [your child]?”

Child is sung to or told stories every day: This measure was assessed for children ages 0 to 5 based on the

number of days during the past week that parents reported that “[they] or other family members [told] stories

or [sang] songs to” the child.

Family eats meals together 6-7 days per week: Parents responded to the question, “During the past week,

on how many days did all the family members who live in the household eat a meal together?”

Extracurricular activity participation: Parents of children ages 6 through 17 answered three questions

regarding whether or not their child had been “on a sports team or ... [took] sports lessons after school or on

weekends,” “participate[d] in any clubs or organizations after school or on weekends,” or “participate[d] in

any other organized events or activities” during the 12 months prior to the survey. Children whose parents

answered “yes” to any of the questions were categorized as having participated in extracurricular activities.

Note: Appendix Table 10 includes two additional measures: 1) involvement in community service or volunteer work, and 2) child attendance

at religious services.

Figure 25. Percentage of children ages 6-17 who participate in one or more organized 

activities outside of school, by adoptive status and by adoption type
32 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

This section examines five indicators related to

parenting: 1) whether the parent-child relationship was rated as very warm and close; 2) the

parent-child relationship compared to parental

expectations; 3) the experience of having the

child in his/her life as compared to parental

expectations; 4) ability to cope with the demands

of parenting; and 5) parental aggravation. Additionally, this section reports on the quality of

the relationship between children’s parents. The

parents’ relationship with each other can influence child well-being. For example, relationship

factors such as positive affect and enjoyment

have been linked with fewer child behavior

problems.29 For definitions of each measure, see

the text box labeled “Measures of parenting and

parent well-being.” See Appendix Table 11 on

page 70 for detailed data on each indicator.

The majority of adopted children fare well

according to parenting measures, with a substantial portion having parents who rated the

parent-child relationship and having the child in

their lives as “better than they ever expected.”

Overall, 81 percent of adopted children have

parents who described their relationship with

their child as very warm/close, and 42 percent

have parents who reported that the relationship

is “better than ever expected.” Fifty-one percent

of adopted children have parents who reported

that having the child in their lives is better than

they ever expected. Just over half (53 percent)

also have parents who feel that they cope “very

well” with the demands of parenting. Eleven

percent have parents who experience parental

aggravation; see Figure 26.

Furthermore, for the vast majority of adopted

children living with two parents, their parents’

relationship quality is high. Parental reports

regarding the happiness of their relationships

with their spouses or partners indicate that,

among adopted children living with two

parents, nearly nine out of ten have parents 

who reported that their relationship was “very

happy” or “completely happy;” see Figure 27.

Adopted children are somewhat less likely than

children in the general population to fare well

on the parenting measures, but they are more

likely to have parents who have satisfying

relationships. Adopted children are somewhat

less likely than those in the general population

to have parents who reported that they cope

“very well” with the demands of parenting (53

compared with 60 percent).i And, while parental

aggravation is rare among all children, regardless of adoptive status, adopted children are

more likely than children in the general U.S.

population to have an aggravated parent (11

compared with 6 percent). However, adopted

children live with parents who are at least as

happy with each other as parents of children in

the general population. Indeed, adopted children are somewhat less likely than children in the

general population to have parents who said their

relationship was either “fairly happy” or “not too

happy” (12 and 17 percent, respectively).

Children adopted from foster care fare less well

than internationally adopted children on some

parenting measures; on other measures there were

no differences among adoption types. Specifically,

the percentage of children adopted from foster

care with parents who reported the parent-child

relationship being “better than ever expected” is

lowest for children adopted from foster care (36

percent) and highest for internationally adopted

children (46 percent). Similarly, 40 percent of

children adopted from foster care have parents

who reported that having the child in their lives 

is “better than they ever expected,” compared

with 54 percent of privately adopted U.S. children

and 62 percent of internationally adopted

children. Furthermore, children adopted from

foster care are more likely to have aggravated

parents than privately adopted U.S. children or

internationally adopted children (16 percent,

compared with 7 and 9 percent, respectively); 

see Figure 28. However, parents’ reports

regarding how well they cope with the demands

of parenting do not differ by adoption type, nor

does the quality of parents’ relationships.

Parenting and parent well-being

i This difference is concentrated among adolescents. For adopted adolescents ages 12 to 17, 47 percent have parents who reported that they

coped “very well,” compared with 55 percent of the general population of adolescents.
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 33

0

10

20

30

40

50

60

70

80

90

100

Percent

81%

42%

51% 53%

89%

Parent-child

relationship 

“very warm and 

close”

Parent-child

relationship “better

than ever

expected”

Having children

in parent’s life 

“better than ever 

expected”

Parent copes 

“very well” with

the demands of

parenting

Parent 

NOT 

aggravated

 

 

 

MEASURES OF PARENTING AND PARENT WELL-BEING

Spouse/partner relationship quality: To assess the relationship quality of parents who have a spouse or

partner, we identified parents who described their relationship as “completely happy” or “very happy,” as

opposed to “fairly happy” or “not too happy.”

Parent-child relationship very warm/close: Based on parents’ responses to the question, “How would you

describe your relationship to [your child]?” we examined children whose parents responded “very warm and close,”

compared with those who responded “somewhat warm and close,” “somewhat distant,” or “very distant.”

Parent-child relationship, compared to parental expectations: This indicator is based on the question,

“Thinking about [your child]’s relationship with you, would you say things are better than you ever expected,

about what you expected, or more difficult than you ever expected?”

Having the child in their life, compared to parents’ expectations: Parents answered the question, “So

far, how has having [the child] in your life compared with what you thought it would be like?” Responses

included “better than you expected,” “about what you expected,” and “more difficult than you expected.”

Ability to cope with the demands of parenting: Parents also answered the question, “How well do you

feel you are coping with the day to day demands of parenthood?” We identified parents who responded 

“very well,” versus those who responded “somewhat well,” “not very well,” and “not very well at all.”

Parent aggravation: Parental aggravation was assessed based on parents’ ratings of how frequently during

the prior month they felt the child “[was] much harder to care for than most children his/her age” and “[did]

things that really bothered [the parent] a lot,” and how often they “felt angry with him/her.” A scale score 

was calculated such that typical parental responses of “sometimes,” “usually,” or “always,” rather than “never”

or “rarely,” indicated parental aggravation. 

Note: Appendix Table 11 includes two additional measures: 1) the relationship of the parent’s spouse/partner to the child is very warm and

close, and 2) the relationship of the parent’s spouse/partner to the child, compared to parental expectations. 

Figure 26. Percentage of adopted children according to parenting and 

parent-child measures
34 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

 

 

 

All children 

with two parents

Adopted children

with two parents

Fairly or 

not too happy

17% Completely

happy

35%

Very happy

48%

Fairly or 

not too 

happy

12%

Completely

happy

38%

Very happy

49%

Figure 27. Percentage distribution of all children and all adopted children, by reported 

satisfaction of parent with spouse/partner relationship quality

0

10

20

30

40

50

60

70

80

90

100

75%

85% 85%

Parent-child

relationship 

“very warm and 

close”

Parent-child

relationship “better

than ever

expected”

Having child

in parent’s life 

“better than ever 

expected”

Parent

NOT

aggravated

36%

44% 46%

40%

54%

62%

84%

93% 91%

Foster care

Private domestic

International

Percent

 

 

 

 

 

 

Figure 28. Percentage of adopted children according to parenting and parent-child 

measures, by adoption type
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 35

To examine adoption satisfaction, this section

reports on three measures: whether parents

would make the same decision to adopt their

child again, whether parents considered

dissolving the adoption, and parental perceptions of their child’s feelings about being

adopted. See Appendix Table 12 on page 72 

for detailed data on each indicator.

Very few adopted children (3 percent) have

parents who say that they “probably would 

not” or “definitely would not” make the same

decision to adopt their child. In fact, 87 percent

of adopted children have parents who said they

would “definitely” make the same decision. 

This percentage varies somewhat by adoption

type with 93 percent of privately adopted U.S.

children, 87 percent of internationally adopted

children, and 81 percent of children adopted

from foster care having parents who expressed

this opinion;i see Figure 29.

Very few adopted children have parents who

reported ever having considered dissolving the

adoption. The number of children whose parents

reported ever considering dissolution was too

small to generate reliable estimates of its

frequency. It should be noted, however, that

families in which the child’s adoption has been

legally dissolved do not appear in the survey

sample. Furthermore, parents were only asked this

question if they had reported the adoption had

negatively affected their family or that they would

definitely or probably not have accepted the child,

knowing everything they now know about the

child.

The vast majority of adopted children have

parents who reported that their child feels

positive about their adoption. More than nine

out of ten adopted children ages 5 and older 

(92 percent) have “positive” or “mostly positive”

feelings about their adoption, according to their

parents.30 This is true regardless of adoption type

and regardless of the child's age; overall, 49

percent of adopted children were reported as

having positive feelings and 43 percent were

reported as having mostly positive feelings

about their adoption. 

MEASURES OF ADOPTION SATISFACTION

Parents would make the same decision to adopt

their child: Parents were asked, “If you (and your

spouse/partner) knew everything about [your child]

before the adoption that you now know, how might 

that have affected your decision to accept him/her for

adoption?” Responses included whether the parent

would have “definitely,” “probably,” “probably not,” 

or “definitely not” have accepted the child.

Parent considered dissolving the adoption:

Parents were first asked how having their child in

their life affected their family and whether they

would have made the same decision to adopt the

child. If they responded that the child affected their

life “somewhat” or “very negatively” or that they

would “probably” or “definitely not have accepted

the child,” they were asked: “Have you [or your

spouse/partner] ever thought about ending this

adoption?” We identified parents who answered

“yes,” compared with those who answered “no” 

or who were not asked the question due to their

responses to the previous questions.

Parents’ perceptions of the child’s feelings

about adoption: Parents of children at least five

years old were asked, “Overall, how do you think

[your child] feels about being adopted?” Responses

included that the child feels “positive,” “mostly

positive,” “neither positive nor negative,” “mostly

negative,” or “negative” about it. Three percent of

children ages 5 and older were excluded from this

analysis because their parents reported that the child

did not know that he or she had been adopted.

Adoption satisfaction

i The difference between the percentage for children adopted from foster care and those adopted internationally (81 compared with 87

percent) is marginally significant (p<.1). The difference between private domestic and international (93 and 87, respectively) is also

marginally significant (p<.1).

 

 

 

Percent

6%

Probably or 

definitely NOT

Probably 

would

Definitely

would

14%

6%

93%

87%

81%

9%

Note: Values corresponding to unreliable percentage estimates 

have been suppressed in this figure.

0

10

20

30

40

50

60

70

80

90

100

Foster care

Private domestic

International

Figure 29. Percentage of adopted 

children according to whether their 

parents would make the same decision 

to adopt again, by adoption type
36 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

MEASURES OF PARENTAL INVOLVEMENT AND ADVOCACY IN THE ADOPTION COMMUNITY

Parent helped other adoptive families: To assess whether parents had helped other families, we examined

whether parents said they or their spouse or partner had “ever been asked by anyone to assist in helping other

adoptive families” and, for those who answered “yes,” whether they did “assist in helping other adoptive families.”

Parent recruited other adoptive families: This measure depended upon parents’ reports regarding whether

they or their spouse or partner had ever been asked “to recruit other adoptive families” and, for those who

answered “yes,” whether they had done so.

This section examines whether adoptive parents

have ever helped other adoptive families, for

example, whether they have mentored new

adoptive parents, and whether they have recruited

other families to adopt children. See Appendix Table

13 on page 73 for detailed data on each indicator.

Most adopted children have parents who had

never been asked to help or recruit other adoptive

families. Specifically, 56 percent of adopted children have parents who reported never having been

asked to help, and 92 percent have parents who

reported never having been asked to recruit other

families. Very few children have parents who

declined to help when asked. Only 3 percent of

adopted children have parents who reported that

they had not helped if asked to assist other

adoptive families; see Figure 30. Two percent have

parents who declined to recruit other adoptive

families; see Figure 31. These figures suggest that

adoptive parents are a largely untapped resource

of individuals who may be willing to help or to

recruit other adoptive families.

Internationally adopted children are the most

likely to have parents who helped other adoptive

families. And although recruiting by parents 

was rare among children with all three types of

adoptions, children adopted from foster care are

the most likely to have parents who recruited

other adoptive families. Specifically, 60 percent 

of internationally adopted children have parents

who reported that they helped other families,

compared with 38 and 34 percent of children

adopted from foster care and privately in the

United States, respectively; see Figure 32. Parents

of nine percent of children adopted from foster

care reported recruiting other adoptive families.

Parent involvement and advocacy 

in the adoption community

Helped 

other

adoptive

families

42%

Was not

asked to

help other

adoptive

families

56%

Was asked, but did not help 

other adoptive families 3%

 

 

 

 

 

 

Figure 30. Percentage distribution of

adopted children according to whether

parents helped other adoptive families

 

 

Was not

asked to recruit other

adoptive families

92%

Was asked, but did not 

recruit other adoptive 

families 

2%

Recruited other 

adoptive families 

6%

 

 

Figure 31. Percentage distribution of

adopted children according to whether

parents recruited other adoptive families
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 37

0

10

20

30

40

50

60

70

80

90

100

Percent

38%

34%

60%

Helped other adoptive 

families

Was asked, but did not help

other adoptive families

Was not asked to help other

adoptive families

60%

64%

36%

Note: Values corresponding to unreliable percentage estimates have been suppressed in this figure.

Foster care

Private domestic

International

Figure 32. Percentage distribution of adopted children according to whether 

parents helped other adoptive families, by adoption type
38 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

This section examines adoptive parents’ prior

experience with adoption. See Appendix Table 14

on page 74 for detailed data.

Three out of four adopted children have parents

who have some prior experience with or connection to adoption. Six percent of adopted children

have a parent who was himself or herself adopted.

Given that the proportion of the general child

population that is adopted is 2 percent, it seems

likely that adopted children are more likely to 

have a parent who was adopted than are children

in the general population. Four percent have 

an aunt or uncle who was adopted, but did not

have an adopted parent, an additional 31 percent

have other relatives who were adopted, and an

additional 35 percent have parents with friends

who have adopted. Twenty-four percent of

adopted children have parents who reported 

no prior connection to adoption; see Figure 33.

Among adopted children, those adopted

internationally were the most likely to have a

parent with some prior personal connection to

adoption, whereas those adopted privately from

the United States were the least likely. Specifically,

10 percent of children adopted internationally

have a parent with no prior connection to

adoption compared with 33 percent of those

adopted privately from within the United States.

Compared to other adopted children, those

adopted internationally are particularly likely to

have a parent who had friends who had adopted;

see Figure 34.

Parents’ prior connections to adoption

 

Child’s aunt/uncle

was adopted

4%

Either parent was adopted

6%

Other

relative was 

adopted

31%

Parent’s friends 

have adopted

35%

No prior

connection to 

adoption

24%

Figure 33. Percentage distribution of

adopted children by parents’ prior 

connection to adoption

Percent

Either parent was

adopted

Child’s aunt/uncle

was adopted

Other relative

was adopted

7% 4% 6% 4% 3%

30% 30% 33% 30% 32%

26%

33%

10%

48%

Parent’s friends

have adopted

No prior connection

to adoption

 

 

 

 

 

 

 

Note: Values corresponding to unreliable percentage estimates have been suppressed in this figure.

Foster care

Private domestic

International

0

10

20

30

40

50

60

70

80

90

100

Figure 34. Percentage distribution of adopted children by parents’ prior 

connection to adoption, by adoption type
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 39

MEASURES OF PARENTS’ PRIOR CONNECTIONS TO ADOPTION 

We identified parents’ prior connections to adoption by examining their responses to a series of questions. First,

we identified adopted children whose parent reported that either they or their spouse or partner (if they had

one) had been adopted as a child. Among those adopted children who did not have a parent who had been

adopted, we next identified those who had an aunt or uncle who had been adopted, based on their parent’s

responses to the question, “Do you [or your spouse/partner] have siblings who were adopted?” To identify

whether any of the remaining adopted children had any other relatives who had been adopted, we looked at

parental responses to the question, “Do any of your [or your spouse’s/partner’s] relatives have adopted children?”

Next, for all adopted children who had no parents or relatives who had been adopted, we identified those whose

parent reported having “friends or close acquaintances” with adopted children. We assumed that if parents

answered “no” to all the prior questions, children’s parents had no prior connection to adoption.
40 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

Part 2:

The Adoption Process

Part 2 presents findings about the adoption

process. Information presented includes

parents’ motivation to adopt, parental satisfaction

with the agency or attorney that assisted them in

the adoption, and adoption expenses. In addition,

this section includes information about the

openness of adoptions as well as on the postadoption services and supports families receive.

Because this section includes information specific

to the adoption process, comparisons with

children in the general population are not

included.

KEY FINDINGS

• Adopted children typically have parents who said they chose to adopt in order to provide a permanent home 

for a child, to expand their family, and/or because of infertility. Among the three adoption types, children 

adopted from foster care are least likely to have parents report infertility as a motivation for adoption, and 

most likely to report being motivated because they had previously adopted the child’s sibling.

• Nearly nine out of ten adopted children have a parent who was satisfied with their adoption attorney or 

agency; more than nine out of ten believe that the agency disclosed all important information prior to the 

adoption. Children adopted from foster care are slightly less likely to have parents who were satisfied with 

the adoption agency or attorney, but the perception of failure to disclose important information prior to the 

adoption was rare across all three groups of adopted children. 

• Adoption expenses for children adopted privately in the United States or internationally are considerably 

higher than for children adopted from foster care. 

• Almost all adopted children ages 5 and older (97 percent) know they were adopted. Among children adopted 

by non-relatives, about one-third have a pre-adoption agreement regarding openness, and roughly one-third 

have had post-adoption contact with birth family members.

• Three out of ten adopted children have a parent who reported that at least one adoption-specific support they 

needed was not received. Such supports include meeting with agency staff, child and parent adoption support 

groups, parent training, and web-based resources. Receipt of these services varies by adoption type, with 

children adopted internationally typically the most likely to have parents who received particular services.

• Just over one out of five adopted children (21 percent) has a parent who reported not receiving at least 

one needed service not specific to adoption. Such services include child mental health care, family and crisis

counseling, child residential treatment or hospitalization, and child drug or alcohol services, tutoring, and 

mentoring. In a few cases, receipt of services varies by adoption type, with children adopted from foster care 

typically more likely than other adopted children to have received particular services.

• More than three-fourths of children adopted from foster care receive an adoption subsidy (78 percent); 

64 percent have an adoption agreement that allows for both a subsidy and health insurance coverage.
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 41

This section examines adoptive parents’ motivation to adopt. Examining why parents choose 

to adopt and how those reasons are similar 

and different across adoption types may inform

agencies’ recruitment efforts. See Appendix Table

15 on page 74 for detailed data on each indicator.

Adopted children typically have parents who 

said they chose to adopt in order to provide a

permanent home for a child, to expand their

family, and/or because of infertility. Children’s

parents reported whether five possible reasons

for choosing to adopt applied to them. The most

commonly reported reason was to provide a

permanent home for a child in need (81 percent),

followed by a desire to expand their family (69

percent), inability to have a biological child (52

percent), wanting a sibling for another child (24

percent), and having previously adopted the

child’s sibling (7 percent). Some respondents also

volunteered additional reasons for adopting,

including being related to the child prior to the

adoption, having already formed a bond with or

loved the child, loving children in general, and

helping a child avoid foster care.

The reported motivation to adopt differs by

adoption type. Although the ordering of the

frequency with which these reasons are reported

is generally the same across adoption types, the

percentages of children whose parents reported

each reason differ. For example, children adopted

internationally are more likely than children

adopted from foster care or privately adopted

U.S. children to have parents report that they

were motivated by a desire to expand their family

(92 percent compared with 61 and 60 percent,

respectively), by infertility (72 percent compared

with 39 and 52 percent), or by a desire for a

sibling for their child (36 percent compared 

with 24 and 16 percent). Additionally, children

adopted internationally are more likely than

privately adopted U.S. children to have parents

report being motivated by a desire to provide 

a permanent home for a child (90 percent compared with 70 percent); see Figure 35. Among 

the three adoption types, children adopted from

foster care are least likely to have parents report

infertility as a motivation for adoption, and most

likely to report being motivated because they 

had previously adopted their child’s sibling.i

Parents’ motivation to adopt

i The difference in percentages of children adopted from foster care and those adopted from other domestic sources is marginally significant for

reports that parents were motivated by already having adopted their child’s sibling (p<.10).

 

 

 

0

10

20

30

40

50

60

70

80

90

100 90% 92%

39%

52%

72%

86%

70%

24%

16%

36%

11% 7%

To provide a permanent 

home for a child

Percent

Note: Values corresponding to unreliable percentage estimates have been suppressed in this figure.

To expand family Infertility Wanted sibling

for a child

Had adopted

child’s siblings

61% 60%

 

Foster care

Private domestic

International

Figure 35. Percentage of adopted children by parents’ reasons for 

choosing to adopt, by adoption type

MEASURES OF PARENTS’

MOTIVATION TO ADOPT 

To assess parents’ motivations for adopting, the NSAP

interviewer asked parents to report whether each of

a series of possible reasons for deciding to adopt a

child applied to them. The motivations included:

• inability to have a biological child, 

• wanting to expand their family, 

• wanting a sibling for another child, 

• already having adopted their child’s sibling, and 

• wanting to adopt a child in need of a permanent family. 

Additionally, parents were asked whether there was

any other reason. Some of the most common

additional explanations were that the parent had

already formed a bond with or loved the child, or

that the parent was related to the child.
42 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

MEASURES PERTAINING TO PARENTS’ SATISFACTION WITH 

AGENCY OR ATTORNEY

Parents’ satisfaction with their adoption attorney or agency was assessed based on whether parents

reported that overall their experience was “very positive, positive, mixed, negative, or very negative.” A small

portion of adopted children (1 percent) had parents who reported having used neither an adoption agency 

nor an attorney for the adoption. These children were excluded from the analysis regarding their parents’

satisfaction with their agency or attorney.

Disclosure of important information prior to the adoption: Parents reported whether they “believe that

the agency knew important information” about their child that the agency did not share prior to the

finalization of the adoption.

Note: Two additional measures relevant to foster care adoption are reported in Appendix Table 16. These asked foster parents who

fostered prior to the adoption: 1) whether options other than adoption were discussed with parent(s), and 2) whether the parent(s) felt

pressured by the agency to adopt the child.

This section examines adoptive parents’

satisfaction with their adoption agency or

attorney. See Appendix Table 16 on page 75 

for detailed data on each indicator.

Nearly nine out of ten adopted children have 

a parent who is satisfied with their adoption

attorney or agency; more than nine out of ten

believe that the agency disclosed all important

information prior to the adoption. Specifically,

89 percent of adopted children have parents

who reported either a “very positive” or

“positive” experience with their attorney or

agency. Overall, 8 percent of adopted children

have a parent who reported that they believe

important information was not disclosed to

them prior to the adoption.

Satisfaction with the adoption agency or

attorney varies by adoption type. Children

adopted from foster care are somewhat less

likely to have parents who had a “very positive”

experience than U.S. children adopted privately

or those adopted internationally (48 percent,

compared with 57 percent for both of the other

groups);i see Figure 36.

i The difference for internationally adopted children is marginally significant (p<.10).

Very positive Positive

Percent

Mixed or negative

48%

57% 57%

36%37%

33%

16%

6% 10%

Foster care

Private domestic

International

0

10

20

30

40

50

60

70

80

90

100

Figure 36. Percentage distribution of

adopted children by parents’ reported 

experience with adoption agency or 

attorney, by adoption type

Parents’ satisfaction with

their agency or attorney
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 43

This section examines adoption expenses 

and sources of reimbursement for expenses,

including filing for the federal adoption tax

credit, reimbursement for some or all costs by

the adoption agency (for children adopted 

from foster care only), and employer-provided

financial assistance. The federal adoption tax

credit was established in 1996 to reimburse

parents for adoption-related expenses. As of

2008, the maximum reimbursement amount 

was $11,650; it is phased out for families with

adjusted gross incomes between $174,730 and

$214,730.31 See Appendix Table 17 on page 76

for detailed data on each indicator.

For about one out of three adopted children,

their parents reported paying no adoptionrelated expenses; for four out of ten, expenses

were $10,000 or more. Among children whose

adoptions occurred in 1997 or later, eight out 

of ten have parents who filed for the federal

adoption tax credit. Among all adopted children,

13 percent have a parent who reported receiving

employer-provided financial assistance. 

Adoption-related expenses for the majority 

of children adopted from foster care are low.

Fifty-six percent of children adopted from foster

care have parents who reported incurring no

adoption expenses; parents of an additional 29

percent reported expenses that were less than

$5,000. Fewer than one in ten children adopted

from foster care have parents who said the cost

was $10,000 or more; see Figure 37.

Adoption expenses for children adopted

privately in the United States or internationally

are typically much higher than for children

adopted from foster care. Costs were substantial

for a large proportion of privately adopted U.S.

children, with 20 percent having adoption costs

ranging from $10,000 to $20,000 and 12 percent

with expenses of $20,000 or more. However, 

for 22 percent of children adopted privately in

the United States, parents reported paying no

adoption-related costs. In general, adoption

costs are lower when children are adopted by

relatives, and this is particularly so among

children adopted privately. Among these

children, 94 percent of those adopted by

relatives had expenses less than $5,000, compared with 27 percent of those adopted by

non-relatives. International adoption expenses

tend to be even greater than for privately

adopted U.S. children. Adoption expenses 

were $20,000 or more for 49 percent of 

children adopted internationally.

Children adopted from foster care are less 

likely than other adopted children to have a

parent use the adoption tax credit or to receive

employer-provided financial assistance. Children

adopted internationally are more likely than

other adopted children to have parents who

reported obtaining employer-provided financial

assistance to cover adoption-related expenses.

Twenty-two percent of children adopted

internationally have parents who reported this

type of financial assistance, while these figures

are 6 and 13 percent, respectively, for children

adopted from foster care and privately from 

the United States. Similarly, the percentage 

of parents who claimed the tax credit is higher

for those who adopted privately from the

United States (84 percent) and internationally

(86 percent) than for those who adopted from

foster care (66 percent). However, these lower

rates among parents adopting from foster care

may reflect their use of different financial

supports. In most states, the public child welfare

agency reimburses families for most, if not all, 

of adoption-related costs for parents who 

adopt children from foster care. Accordingly,

substantial proportions of children adopted

from foster care have parents who reported 

no adoption-related costs (56 percent) or 

having been reimbursed by their adoption

agency (39 percent).

Adoption expenses
44 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

Note: Values corresponding to unreliable percentage estimates have been suppressed in this figure.

0

10

20

30

40

50

60

70

80

90

100

6%

13%

9%

33%

5%

93%

56%

22%

29%

33%

No cost

Percent

More than $0 but

less than $5,000

At least $5,000 but

less than $10,000

$10,000 or more

3

 

 

 

Foster care

Private domestic

International

MEASURES PERTAINING TO ADOPTION EXPENSES

Adoption expenses: The survey initially asked parents, “Did you pay anything at the time of the adoption, 

for example, did you pay for a home study or pay an attorney?” Those who said “no” were not asked any

further questions about cost or about whether they were reimbursed for any costs. It is not clear whether

families who were fully reimbursed for adoption-related expenses would have responded that they incurred

any costs at the time of the adoption, or whether they would have reported no adoption expenses. Among

those who responded “yes,” they had paid something at the time of the adoption, information on adoptionrelated costs was collected differently depending on adoption type. Parents of children adopted privately in 

the United States or internationally reported costs in increments of $5,000 up to “$40,000 or more.” Parents 

of children adopted from foster care reported costs in increments of $5,000 up to “$10,000 or more.” See

Appendix Table 18 for details on adoption expenses for children adopted privately or internationally. 

Sources of reimbursement for adoption expenses: Parents reported whether they were aware of and 

had filed for the federal adoption tax credit, whether their adoption agency had reimbursed all, some, or 

none of these expenses, and whether they or their spouse’s employer had provided financial assistance for 

the adoption.

Figure 37. Percentage distribution of adopted children according to 

the cost of the adoption, by adoption type 
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 45

In the adoption process, “openness” refers to the

extent to which all parties (including the adopted

child and birth-family members) are informed

about past and present relationships, and are

able to initiate and maintain contact with each

other. To examine adoption openness, this section

first identifies whether or not children are aware

that they have been adopted. This section also

describes whether children’s families have preadoption agreements regarding openness, and

whether adopted children have had postadoption contact with members of their birth

family. In “closed” adoptions, birth and adoptive

parents had no contact with each other; often

knowing very little—if anything—about each

other. In some cases, adoptive parents did not tell

their children that they had been adopted. The

1960s brought a shift toward more openness in

adoption.32 Although the effect of continued

contact and communication between adopted

individuals and birth parents has been difficult to

study, its proponents believe it can facilitate the

psychological well-being of both groups.33 In

many states, agreements about post-adoption

contact—both for privately adopted children 

and for children adopted from foster care—are

legally enforceable, providing some assurance 

to birth parents of the continued openness of 

an adoption.34 See Appendix Table 18 on page 

77 for detailed data on each indicator.

Almost all adopted children ages 5 and older (97

percent) know they were adopted. There are small

differences across adoption type, with children

adopted from foster care slightly less likely to know

they were adopted (94 percent), compared with

other adopted children. 

Among children adopted by non-relatives,i

about one-third have a pre-adoption agreement

regarding openness. Roughly one-third have had

post-adoption contact with birth family members.

Specifically, the parents of 32 percent of adopted

children reported pre-adoption agreements

regarding contact, such as visits or phone calls

with birth family members, or the exchange of

photographs. For 36 percent, either the child or

the child’s parents have had post-adoption

contact with the child’s birth family, either in

person, or through letters or email.

Pre-adoption agreements and post-adoption

contact are most common among children

adopted privately from within the United States.

Specifically, 67 percent of privately adopted 

U.S. children have pre-adoption agreements

compared with 32 percent of children adopted

from foster care. Respondents who adopted

internationally reported pre-adoption agreements so rarely that a reliable estimate cannot be

generated. Similarly, over two-thirds of privately

adopted U.S. children (68 percent) have had

contact with their birth families following the

adoption, as have almost two-fifths of children

adopted from foster care (39 percent). Six percent

of children adopted internationally have had

post-adoption contact with their birth families;

see Figure 38.

Adoption openness

i Parents who were related to their child prior to the adoption were not asked about whether they had pre-adoption agreements regarding openness.

 

 

 

32%

67%

39%

68%

6%

Pre-adoption

agreement regarding

openness

Post-adoption

contact with 

birth family

Note: Values corresponding to unreliable percentage estimates 

have been suppressed in this figure.

Percent

0

10

20

30

40

50

60

70

80

90

100 Foster care

Private domestic

International

Figure 38. Percentage of children adopted

by non-relatives who have pre-adoption

agreements regarding openness and who

have had post-adoption contact with 

birth family members, by adoption type
46 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

MEASURES PERTAINING TO OPENNESS IN ADOPTION

Child knows he/she was adopted: We derived this measure from a question to parents of children ages 

5 and older regarding how their children feel about being adopted. In response, some parents volunteered 

that their children did not know they had been adopted.

Pre-adoption agreement regarding openness: A pre-adoption agreement regarding openness may 

range from informal discussion to a written, signed contract regarding contact between adopted children and

members of their birth family following the adoption. Such agreements are also sometimes called “cooperative

adoption” or “open adoption” agreements. In the NSAP, interviewers asked parents whether there was “any

kind of pre-adoption agreement in which you agreed to provide information about [your child] to one or both

of his/her birth parents or other birth family members.” Children whose parents were related to them prior to

the adoption were excluded from this analysis because they were not asked about pre-adoption openness

agreements. 

Post-adoption contact with birth family members: This measure was based on parental report about

whether they, their spouse or partner, or their child have “ever had contact with his/her birth family members”

since the time of the adoption. Note that the contact may have been between the birth family and the

adoptive parents rather than directly with the child, and that contact may have been via letter, email or in

person. Children whose parents were related to them prior to the adoption were excluded from this analysis

because they were not asked about post-adoption contact.
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 47

Post-adoption supports include an array of services

and other assistance that families may receive

after adopting a child.35 In this section, we discuss

several categories of supports. Supports specific to

adoption include meeting with agency staff, child

and parent adoption support groups, parent

training, and web-based resources. Financial

supports available specifically for children adopted

from foster care include monthly adoption subsidy

payments and health insurance coverage (i.e.,

Medicaid coverage). Rehabilitative services not

specific to adoption include child mental health

care, family and crisis counseling, child residential

treatment or hospitalization, and child drug or

alcohol services. In this section we also look at

other supports not specific to adoption, including

mentoring and tutoring. See Appendix Table 19

on page 78 for detailed data on each indicator.

ADOPTION-SPECIFIC SUPPORTS

The most commonly reported service received 

was meeting with someone from the adoption

agency to discuss post-adoption services (35

percent). Participating in a parent support group,

participating in parent trainings, and using webbased resources are services that the parents 

of about three out of ten children received

regardless of adoption type. A less common

service is participation in support groups for

children; 11 percent of adopted children ages 5

and older have ever participated in such a group. 

A minority of parents said they wanted but did not

receive services. For example, few adopted children

(7 percent) have a parent who reported not having

met with someone at the agency to discuss postadoption services, but wanting to. For each of the

other services, just over one out of ten children 

had a parent who reported having wanted but not

received a service (16 percent for children’s support

groups, 12 percent for parent trainings, 11 percent

for parent support groups); see Figure 39. Overall,

three out of ten adopted children have a parent

who reported that at least one needed adoptionspecific support was not received.

Receipt of post-adoption services varies by

adoption type, with children adopted 

internationally typically the most likely to have

parents who received particular services. One-half

of children adopted internationally (50 percent) 

have a parent who met with someone from the

adoption agency to discuss post-adoption services,

compared with just over one-third of children

adopted from foster care and one-quarter of

those adopted domestically through other sources

(36 and 25 percent, respectively). Similarly, children adopted internationally are more likely to

have participated in a support group for children

ages 5 and up, to have had a parent participate in

a support group,i and to have a parent who used

web-based resources about adoption. However,

the percentage of adopted children with a parent

who participated in parent training after the

adoption was finalized is higher for foster care

adoptions than for private domestic or international adoptions (38 percent, compared with 25

and 29 percent, respectively);ii see Figure 40.

The majority of children adopted from foster care

receive an adoption subsidy and health insurance

coverage through an adoption agreement. Over

three-quarters of children adopted from foster

care (78 percent) receive a monthly adoption subsidy payment. Nearly two-thirds (64 percent) have

an adoption agreement guaranteeing both an

adoption subsidy and health insurance coverage.

 

 

 

7%

16%

11% 12%

Met with

someone 

at agency

Child

support

group 

(ages 5+)

Parent

support

group

Training

for

parent

Percent

 

 

0

5

10

15

20

25

30

35

40

45

50

Figure 39. Percentage of adopted 

children whose parents wanted to 

receive various post-adoption services

(adoption specific) but did not

Post-adoption supports

i This difference is marginally significant (p<.10).

ii The difference in percentages for children adopted from foster care and children adopted internationally (38 compared with 29 percent) is

marginally significant (p<.10).
48 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

0

10

20

30

40

50

60

70

80

90

100

Met with

someone at

agency

Child

support group 

(ages 5+)

Parent

support group

Training

for parent

Use of web 

based resources

36%

50%

25%

8% 10%

25%

29%

21%

24%

53%

26%

29%

19%

38% 38%

Percent

Foster care

Private domestic

International

Figure 40. Percentage of adopted children whose parents received various 

post adoption services (adoption specific), by adoption type

MEASURES RELATED TO POST-ADOPTION SUPPORTS

Adoption agreement, health insurance coverage, and monthly subsidies: Parents reported whether

they had an adoption agreement at the time of their child’s adoption. Such agreements may include monthly

maintenance payments from the agency, health insurance coverage, and other services such as therapy. For

parents who volunteered that they receive a monthly financial subsidy or whose child was covered by public

health insurance, we examined whether these supports were part of the adoption agreement. 

Other supports: Parents reported whether they or their child had received a variety of services and whether

they had wanted to receive each service. The services included:

• Parents meeting with someone at an adoption agency after the adoption was finalized to discuss 

post-adoption services and supports

• Adoption support groups for children ages 5 and older

• Adoption support groups for parents

• Classes, conferences, lectures, or seminars for parents about adoption

• Internet-based resources with information on adoption-related issues 

• Family counseling

• Crisis counseling

• Mental health care or counseling for children ages 5 and older

• Psychiatric hospital, group home, or residential treatment center for children ages 8 and older 

• Alcohol or drug evaluation and/or treatment for children ages 13 and older

• A mentor for children ages 5 and older

• An academic tutor for children ages 5 and older

Rehabilitative services: The rehabilitative services considered here include family counseling; crisis

counseling; mental health care or counseling for children; treatment in a psychiatric hospital, group home, 

or residential treatment center; and alcohol or drug evaluation and/or treatment for children.
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 49

REHABILITATIVE SERVICES AND OTHER

SUPPORTS NOT SPECIFIC TO ADOPTION

Mental health care and tutoring were the most

common services received by adopted children

that were not specifically designed for or targeted

to adoptive families. Among adopted children

ages 5 and over, 39 percent received mental

health care and 36 percent received tutoring.

Families of one out of five adopted children

received family counseling (20 percent). Thirteen

percent of adopted children ages 5 or older had

ever had a mentor. Less common services include

psychiatric residential treatment or hospitalization, and drug and alcohol services for adopted

adolescents, as well as crisis counseling. Over onethird of adopted children received at least one

rehabilitative service, such as family or crisis

counseling, in-patient or out-patient mental

health care, or drug or alcohol treatment services.

For most services not specifically designed for or

targeted to adoptive families, fewer than one out

of ten adopted children have parents who said

they wanted but did not receive each particular

service. The most frequently mentioned services

that had been desired but not received were

mentoring and tutoring (11 percent for each

service). For other services, reports that services

were needed but not received were rarer; see

Figure 41. Looking across all of the supports not

specific to adoption, just over one out of five

parents (21 percent) reported that at least one

needed support was not received. 

Receipt of a few services varies by adoption type;

typically, children adopted from foster care are

more likely than other adopted children to have

received each service. In particular, nearly half of

children adopted from foster care have received

some type of rehabilitative service (46 percent),

compared with 34 percent of children adopted

from other domestic sources and 29 percent of

children adopted internationally. Nearly one-half

of children ages 5 and older adopted from foster

care (46 percent) received mental health care

compared with about one-third of children

adopted domestically through other sources or 

internationally (33 and 35 percent, respectively).i

Children adopted from foster care are also more

likely than U.S. children adopted privately or

internationally adopted children to have received

crisis counseling, and, among those ages 5 and

older, they are more likely than internationally

adopted children to have had a mentor; see

Figure 42. The percentage of adopted children

who failed to receive at least one needed service

also varies by adoption type. Twenty-six percent 

of children adopted from foster care have parents

who reported an unfilled need compared with 

16 percent of children adopted internationally.

4% 6%

3%

11% 11%

Mental

health care

(ages 5+)

Family 

counseling

Crisis

counseling

Tutor

(ages 5+)

Mentor

(ages 5+)

Percent

0

5

10

15

20

25

30

35

40

45

50

Figure 41. Percentage of adopted children

whose parents wanted to receive various

post-adoption services (general) but did not

Mental health care 

for (ages 5+)

Crisis counseling Had a mentor

(ages 5+)

Percent

Note: Values corresponding to unreliable percentage estimates 

have been suppressed in this figure.

 

18% 13%

6% 7%

46%

33%35%

Foster care

Private domestic

International

0

10

20

30

40

50

60

70

80

90

100

Figure 42. Percentage of adopted 

children whose parents received various

post-adoption services (general), by 

adoption type

i The differences are marginally significant (p<.10).
50 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

Technical Appendix

DATA SOURCES

Data for this Chartbook come from the 2007

National Survey of Adoptive Parents (NSAP) 

and from the 2007 National Survey of Children’s

Health (NSCH). Estimates pertaining to the entire

population of U.S. children are based on the

NSCH sample, and estimates pertaining to

adopted children are based on the NSAP sample.

The NSCH is a nationally representative survey 

of U.S. children under age 18. The NSCH uses the

sampling frame of the National Immunization

Survey (NIS), which contacts over a million

households annually. After the NIS screener

and/or survey are completed, the State and 

Local Area Integrated Telephone Survey (SLAITS)

module is administered if households include

any children under age 18. SLAITS has fielded

the NSCH in 2003 and in 2007. In each household, one child under age 18 was randomly

selected, and a parent or guardian knowledgeable about the child’s health answered questions

about the child’s and the family’s health and

well-being and provided information about

demographic characteristics. The 2007 NSCH

included information on 91,642 focal children.

The overall response rate for the NSCH was 

46.7 percent. This percentage accounts not 

only for the rate at which individuals who were

contacted for the survey completed it, but also

for the assumption that some portion of the

sampled phone numbers whose eligibility could

not be determined were, in fact, eligible for the

NSCH interview. Among households in which

someone completed the screener to determine

their eligibility for the NSCH, the interview

completion rate was 66 percent.36

The NSAP is nationally representative of adopted

children ages 0 to 17 in English-speaking

households in the United States in 2007,

excluding those also living with a biological

parent. Collaborative efforts between the Office

of the Assistant Secretary for Planning and

Evaluation (ASPE), the Administration for

Children and Families (ACF), and the National

Center for Health Statistics (NCHS) culminated in

the development of the NSAP survey instrument

and administration of the survey.37 The NSAP was

an add-on module to the 2007 National Survey

of Children’s Health (NSCH).38 If the focal child in

the 2007 NSCH was adopted, an adoptive parent

of the child was asked to participate in the NSAP,

a 30-minute telephone survey. A total of 2,737

focal children were identified as having been

adopted in the 2007 NSCH. NSAP interviews

were carried out between April 2007 and June

2008 regarding 2,089 children. (Adopted

children who were also living with a biological

parent, whose adoptions were assumed to be

primarily step-parent adoptions, were excluded

from the NSAP.)39 The cooperation rate (that 

is, the rate at which NSAP interviews were

completed for children who were identified as

eligible based on the NSCH screener) was high,

at 74.4 percent. However, when other factors are

taken into account, such as the NSCH interview

completion rate,40 the overall response rate for

the NSAP was 34.6 percent. Weighting
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 51

adjustments for NSAP nonresponse greatly

reduce the likelihood of nonresponse bias. 

IDENTIFYING ADOPTED CHILDREN AND

THE TYPE OF ADOPTION

Identifying adopted children in the NSCH who

were eligible for the NSAP, and identifying 

the type of adoption, required several steps. 

All NSCH respondents reported their own

relationship to the child. Those who identified

themselves as a mother or father to the child

were asked whether they were the child’s

“biological, adoptive, step, or foster” parent.

Respondents were asked also whether any other

parents or people who act as the child’s parents

lived with them, and if so, what their relationships to the child were. If there was no biological

parent in the household, interviewers asked

follow-up questions to identify the type of

adoption. Specifically, parents were asked: 

“Was [the child] adopted from another country?”

Positive responses indicated children who had

been adopted internationally. If the answer was

no, parents were asked: “Prior to being adopted,

was [the child] in the legal custody of a state or

county child welfare agency in the United States?

That is, was [the child] in the U.S. foster care

system?” Positive responses indicated children

who were adopted from foster care. All other

adopted children were categorized as those

adopted privately from domestic sources other

than foster care (i.e., U.S. children adopted

privately). 

There are several important exclusions to the

sample of children identified as adopted in 

the NSCH. First, children adopted informally 

and those in pre-adoptive placements are not

included. Parents who answered “no” to the

question, “Has [the child]’s adoption been

finalized?” were not eligible for the NSAP

interview. Finalizing adoptions can take six

months or more from the time a child is placed

with a family with the goal of adoption, even

after the child has been legally freed for

adoption.41 Most of these children were likely

later adopted by their parents, but it is possible

that for some others, the adoption disrupted

(i.e., the adoption was aborted prior to legal

finalization.) Excluding children whose

adoptions had not been legally finalized 

also means that the sample does not include

dependent children being reared by caregivers

in informal adoption arrangements, many of

whom may be related to children but not as

biological parents.42 Informal adoptions are

more common among some cultures, including

black and Hispanic families, than others.43

Another important exception is that the NSAP

excluded children who were living with one

biological and one adoptive parent. Most of

these children are in step-families. According 

to estimates from the Census, at least 4 percent

of all children—approximately two-thirds of 

all adoptions—in the United States are in stepparent adoptions.44

Thirdly, the NSAP does not include children

whose adoptions had already been dissolved

(i.e., whose adoptions were reversed following

legal finalization.) Therefore, while the NSAP

addressed topics such as adoption satisfaction

and whether parents ever considered dissolving

an adoption, it cannot address topics such as

why families with dissolved adoptions chose 

to end the adoption.

DATA ANALYSIS

Administering the NSAP as an add-on to the

NSCH not only allows for a representative

sample of adopted children, but it also allows

for comparisons of adopted children with

children in the general population on the health

and well-being measures collected by the NSCH.

For our analyses, we merged variables from 

the NSCH onto NSAP records (i.e., we created 

a linked NSAP-NSCH file). This enabled us to

calculate estimates pertaining to NSCH variables

for adopted children. Estimates pertaining to

adopted children in this Chartbook are always

based on the NSAP sample.45 Estimates pertaining to all children are based on the NSCH

sample and do not exclude adopted children, 

in order to represent the general population 

of U.S. children.

To yield representative samples of children in

each state, the NSCH used complex sampling

methods involving the clustering of children

within households and stratification of
52 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

households within states. The complex sampling

methodology means that, in order to generate

estimates of variance that are not biased

downward, analyses must take advantage of

stratum and primary sampling unit (PSU)

identifiers, as well as weights that have been

adjusted for unequal sampling probability.46

The weights, which have also been adjusted for

non-response and which were further adjusted

to match pre-existing population control totals,

are also necessary in order to generate parameter estimates (e.g., percentages) that can 

be extrapolated to the overall populations of

children that the NSCH—and the NSAP—are

intended to represent.

We used the statistical software package Stata 

in order to account for the complex sampling

methodology in both the NSCH and NSAP.

Additionally, all analyses were weighted. We

generally avoided reporting estimates for which

the relative standard error exceeded 0.3, and—

at a minimum—flagged such estimates in the

appendix tables to denote their imprecision. We

also omitted value labels for percentages with

relative standard errors exceeding 0.3 from the

figures in the Chartbook. Additionally, we tested

whether variables were associated by examining

chi-square statistics. When chi-square statistics

indicated that variables were associated, we

tested differences between pairs of groups of

sampled children (such as those adopted from

foster care versus those adopted internationally

or privately and domestically, as well as those

adopted by relatives versus non-relatives) by

calculating t-statistics for each difference. To test

whether differences between adopted children

and all children were statistically significant, we

calculated t-statistics that accounted for the fact

that the NSAP was a subsample of the NSCH. 

All comparisons between groups that are highlighted in text are statistically significant at the

.05 level of significance; notable differences or

associations that are statistically significant at

the .10 level were also in some cases mentioned

and footnoted as “marginally significant” at 

the .10 level. 

AVAILABILITY OF DATA

Researchers can carry out more complex analyses

of the NSAP and the NSCH by obtaining public

use versions of the datasets, available at:

http://www.cdc.gov/nchs/slaits.htm

The linked version of the NSCH and NSAP used

for the analyses in this chartbook is not publicly

available. Researchers interested in analyzing

linked NSCH-NSAP data may apply for access to

restricted data through the NCHS Research Data

Center at http://www.cdc.gov/nchs/r&d/rdc.htm.
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 53

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

adoption practice. Available online at: www.Childwelfare.gov/pubs/f_basicsbullentin/.

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.

http://www.childwelfare.gov/pubs/f_adoptoption.pdf.

4 For more information, see: http://adoption.state.gov/about/how/childeligibility.html.

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

http://www.childwelfare.gov/pubs/s_disrup.pdf.

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:

http://adoption.state.gov/news/total_chart.html. 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, http://adoption.state.gov/country/china.html.

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

online at http://www.ruvr.ru/main.php?lng=eng&q=18909&cid=59&p=16.11.2007.

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, http://adoption.state.gov/news/total_chart.html.

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:

http://www.acf.hhs.gov/programs/cb/stats_research/afcars/trends.htm.]

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

http://www.cdc.gov/nchs/data/series/sr_23/sr23_027.pdf.

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.)

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

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

http://www.acf.hhs.gov/programs/cb/stats_research/afcars/trends.htm.

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:

http://adoption.state.gov/news/total_chart.html.

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

http://aspe.hhs.gov/poverty/08poverty.shtml). 

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: http://www.census.gov/population/www/metroareas/metroarea.html.

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:

http://www.childtrendsdatabank.org/indicators/5ReadingtoYoungChildren.cfm.

26 For a review, see the National Center for Education Statistic’s article “Reading—Young Children’s Achievement and

Classroom Experiences” available online at: http://nces.ed.gov/pubs2003/2003070.pdf

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

http://www.childtrendsdatabank.org/indicators/96FamilyMeals.cfm.

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

http://www.childtrendsdatabank.org/indicators/86AfterSchoolActivities.cfm.

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 http://www.irs.gov/formspubs/article/0,,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:

http://www.childwelfare.gov/systemwide/laws_policies/statutes/cooperativeall.pdf.
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 55

35 For a more thorough description of post-adoption supports, see http://www.nacac.org/postadopt/postadopt.html.

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 http://www.cdc.gov/nchs/about/major/slaits/nsch07.htm.

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 http://aspe.hhs.gov/hsp/08/CSHCN/rb.shtml.

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 nonbiological 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 stepchildren 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.
56 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

Table 1. Number and percentage distribution of children ages 0-17 by adoptive status; 

number and percentage distribution of adopted children1 ages 0-17 by various characteristics:

United States, 2007

Thousands Percent

All children 73,759 100%

Adopted1 1,782 2%

Health

Special health care needs 14,136 19%

No special health care needs 59,622 81%

All adopted children 1,782 100%

Health

Special health care needs 702 39%

No special health care needs 1,080 61%

Type of adoption

Foster care 661 37%

Private domestic 677 38%

International 444 25%

Prior relationship to parents

Relative 436 24%

Non-relative 1,346 76%

Knew child prior to adoptive match 582 33%

Did not know child previously 1,200 67%

Children adopted from foster care 661 100%

Health

Special health care needs 355 54%

No special health care needs 306 46%

Subsidy receipt

Receiving a subsidy 513 78%

Not receiving a subsidy 148 22%

Prior relationship to parents

Relative 153 23%

Non-relative 508 77%

Knew child prior to adoptive match 262 40%

Did not know child previously 399 60%

Foster parented child prior to adoptive match 454 69%

Was not previously child's foster parent 207 31%

Children adopted privately, domestically 677 100%

Health

Special health care needs 218 32%

No special health care needs 459 68%

Prior relationship to parents

Relative 276 41%

Non-relative 401 59%

Number
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 57

Thousands Percent

Knew child prior to adoptive match 301 44%

Did not know child previously 376 56%

Children adopted internationally 444 100%

Health

Special health care needs 128 29%

No special health care needs 316 71%

Prior relationship to parents

Relative + +

Non-relative 436 98%

Knew child prior to adoptive match + +

Did not know child previously 426 96%

1 Adopted children were defined as those with at least one adoptive parent, but no biological parents, in the household.

+ The relative standard error exceeds 0.30.

NOTE: Percentages may not sum to 100 in percent distributions within categories due to rounding.

SOURCE: 2007 National Survey of Children's Health and 2007 National Survey of Adoptive Parents.

Number

Table 1. Number and percentage distribution of children ages 0-17 by adoptive status; 

number and percentage distribution of adopted children1 ages 0-17 by various characteristics:

United States, 2007. Continued.
58 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

Table 2. Percentage distribution of children ages 0-17 by children’s history and prior relationship

with parents, by adoption type: United States, 2007

Children's history and prior relationship with parents

Percent Percent Percent Percent

Ever lived with birth family

Among all children 43 59 PP, II 39 II 25

By relative/non-relative adoptive status

Among children adopted by relatives 73 78 71 +

Among children adopted by non-relatives 33 53 PP, II 17 24

Where child lived before living with parent

Birth parents/relatives 22 22 PP, II 33 II +

Foster family 22 44 PP, II + II 24

Adopted at birth, or age at adoptive placement < 1 month 32 22 PP, II 62 II +

Congregate care 23 11 PP, II 4 II 70

Other care 1+ + I +

Parent and child were relatives prior to adoptive match 24 23 PP, II 41 II +

Parent knew child prior to the adoptive match 33 40 II 44 II +

Prior relationship to the child

Relative, knew child prior to adoption 21 17 PP, II 37 II +

Relative, did not know child prior to adoption 4 6 II 4 II +

Non-relative, knew child prior to adoption 12 22 PP, II 7 II +

Non-relative, did not know child prior to adoption 64 55 II 52 II 95

Parent was a foster parent to the child

Parents who became foster parents hoping to adopt -- 42 -- --

Parents who fostered without originally intending to adopt -- 33 -- --

Parents who did not foster prior to adoption -- 24 -- --

1 Adopted children were defined as those with at least one adoptive parent, but no biological parents, in the household.

P Significantly different from the estimate for children adopted from private domestic sources (P: p<.10, PP: p<.05).

I Significantly different from the estimate for children adopted internationally (I: p<.10, II: p<.05).

+ The relative standard error exceeds 0.30.

— Not applicable.

NOTE: Percentages may not sum to 100 in percent distributions within categories due to rounding.

SOURCE: 2007 National Survey of Children's Health and 2007 National Survey of Adoptive Parents.

All 

adopted

children1

Foster

care

Private

domestic

International

Type of adoption
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 59

Table 3. Percentage distribution of children ages 0-17 by race, ethnicity, gender, and country of

origin by adoptive status and adoption type: United States, 2007

Child demographics

Percent Percent Percent Percent Percent

Race and Hispanic origin of child

White, non-Hispanic 56 37 ** 37 PP, II 50 II 19

Black, non-Hispanic 14 23 ** 35 PP, II 25 II 3

Asian, non-Hispanic 4 15 ** + II + II 59

Other, non-Hispanic2 6 9 ** 10 II 12 II +

Hispanic origin 20 15 ** 16 13 17

Race and Hispanic origin of parent

White, non-Hispanic -- 73 63 P, II 71 II 92

Black, non-Hispanic -- 17 27 PP, II 19 II +

Asian, non-Hispanic -- + + II + II +

Other, non-Hispanic2 -- 4 + II 4 II +

Hispanic origin -- 557+

Child is male 51 49 57 II 51 II 33

Child gender, by race/Hispanic origin of child

% male, among non-Hispanic white children -- 54 53 58 48

% male, among non-Hispanic black children -- 56 59 51 61

% male, among non-Hispanic Asian children -- 19 + PP, II + 19

% male, among children of Hispanic origin -- 53 65 P 38 55

Trans-racial/ethnic/cultural adoption3 -- 40 28 P, II 21 II 84

Child's region of origin (international adoptions)

Asia -- -- -- -- 61

Europe -- -- -- -- 20

North America -- -- -- -- 13

South America -- -- -- -- 5

Africa -- -- -- -- +

Child's country of origin (international adoptions)

China (mainland) -- -- -- -- 33

Russia -- -- -- -- 13

Guatemala -- -- -- -- 11

South Korea -- -- -- -- 11

India, Kazakhstan, Colombia, Ukraine, Philippines, Ethiopia -- -- -- -- 15

Other -- -- -- -- 16

1 Adopted children were defined as those with at least one adoptive parent, but no biological parents, in the household.

2 This category includes those who reported multiple races.

3 Parents that, compared to themselves and to their spouse/partner, their child was a different race or ethnicity or from a different

culture from themselves. (Children in two-parent families in which the child was reported to be of the same race, ethnicity,

or culture as one parent were not categorized as being trans-racially, trans-ethnically, or trans-culturally adopted.)

* Significantly different from the estimate for all children (*: p<.10, **: p<.05).

P Significantly different from the estimate for children adopted from private domestic sources (P: p<.10, PP: p<.05).

I Significantly different from the estimate for children adopted internationally (I: p<.10, II: p<.05).

+ The relative standard error exceeds 0.30.

— Not applicable or not available.

NOTE: Percentages may not sum to 100 in percent distributions within categories due to rounding.

SOURCE: 2007 National Survey of Children's Health and 2007 National Survey of Adoptive Parents.

All 

adopted

children1

Foster

care

Private

domestic

International

Type of adoption

All 

children
60 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

Table 4. Percentage distribution of children ages 0-17 by other demographic and socio-economic

characteristics, by adoptive status and adoption type: United States, 2007

Other demographic and socio-economic characteristics

Percent Percent Percent Percent Percent

Child's current age

0-2 years 16 6 ** 3 PP,II 6 I 10

3-4 years 11 9 * 6 II 7 II 14

5-9 years 27 30 31 PP,I 22 II 39

10-12 years 17 19 18 22 17

13-14 years 12 14 19 II 14 II 8

15-17 years 17 23 ** 23 II 29 II 12

Parent's current age

Among all children

Under age 40 -- 14 13 15 13

>= 40 and < 50 -- 36 34 II 28 II 51

>= 50 and < 60 -- 37 38 40 I 32

Age 60 or older -- 14 16 II 17 II 5

By presence of parent's spouse/partner status

Among children whose parents have a spouse/partner

Under age 40 -- 17 16 21 14

>= 40 and < 50 -- 41 37 II 35 II 53

>= 50 and < 60 -- 36 39 I 38 II 30

Age 60 or older -- 6 + II 6 II +

Among children whose parents are single

Under age 40 -- 8+++

>= 40 and < 50 -- 27 29 21 43

>= 50 and < 60 -- 38 35 41 38

Age 60 or older -- 26 30 29 +

Spouse/partner's current age (among children whose parents 

have a spouse/partner)

Under age 40 -- 13 + 14 13

>= 40 and < 50 -- 41 36 II 41 48

>= 50 and < 60 -- 38 42 34 36

Age 60 or older -- 9 11 II 10 II +

Age gap between parent/spouse and child (whichever is smaller)

< 30 years -- 10 15 II 11 II +

>= 30 and < 35 years -- 19 16 I 19 22

>= 35 and < 40 years -- 25 24 24 30

>= 40 and < 45 years -- 24 22 23 28

>= 45 and < 50 years -- 12 13 10 13

>= 50 years -- 10 11 II 13 II +

Education of parent with highest level of attainment

Less than high school 9 5 ** 7 ll 6 II +

12 years, high school graduate 23 15 ** 22 P,II 15 II +

More than high school 68 80 ** 70 P,II 79 II 95

Household income-to-poverty ratio2

At or below 100% poverty level 18 12 ** 16 II 17 II +

Above 100% to at or below 200% poverty level 21 19 30 PP,II 18 II +

Above 200% to at or below 300% poverty level 18 17 19 II 20 II 11

Above 300% to at or below 400% poverty level 14 14 9 II 12 II 24

Above 400% poverty level 30 37 ** 25 PP,II 33 II 58

All 

adopted

children1

Foster

care

Private

domestic

International

Type of adoption

All 

children
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 61

Table 4. Percentage distribution of children ages 0-17 by other demographic and socia-economic

characteristics, by adoptive status and adoption type: United States, 2007. Continued.

Other demographic and socio-economic characteristics

Percent Percent Percent Percent Percent

Parental employment3

Among all children

Parents work full-time -- 34 31 II 31 II 43

Other work schedule -- 43 45 P 37 II 51

Parents are retired -- 8 6 PP,II 15 II +

No parents work (excluding retirees) -- 15 18 II 18 II +

By child's current age

Among children ages 0-5

Parents work full-time -- 39 43 P 28 II 46

Other work schedule -- 53 44 59 52

No parents work (including retirees) -- +++ I +

Among children ages 6-11

Parents work full-time -- 32 29 I 27 II 42

Other work schedule -- 47 54 PP 37 I 51

No parents work (including retirees) -- 21 17 PP,II 36 II +

Among children ages 12-17

Parents work full-time -- 34 31 35 40

Other work schedule -- 35 36 I 29 II 51

No parents work (including retirees) -- 31 33 II 36 II +

1 Adopted children were defined as those with at least one adoptive parent, but no biological parents, in the household.

2 Parents reported their total combined family income during the prior calendar year for all members of the family, before taxes. 

The amount was then compared with the federal poverty threshold, as established by the U.S. Department of Health and Human 

Services (http://aspe.hhs.gov/poverty). 3 The "full time" category includes children with single parents working full-time or two parents, both working full-time. 

The "retired" category includes children with single parents who are retired and with two parents, both of whom are retired.

* Significantly different from the estimate for all children (*: p<.10, **: p<.05).

P Significantly different from the estimate for children adopted from private domestic sources (P: p<.10, PP: p<.05). I Significantly different from the estimate for children adopted internationally (I: p<.10, II: p<.05).

+The relative standard error exceeds 0.30.

— Not applicable or not available.

NOTE: Percentages may not sum to 100 in percent distributions within categories due to rounding.

SOURCE: 2007 National Survey of Children's Health and 2007 National Survey of Adoptive Parents.

All 

adopted

children1

Foster

care

Private

domestic

International

Type of adoption

All 

children
62 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

Table 5. Percentage distribution of children ages 0-17 by family characteristics and structure,

by adoptive status and adoption type: United States, 2007

Family characteristics and structure

Percent Percent Percent Percent Percent

Child’s birth siblings

Child has birth siblings never available for adoption -- 25 19 PP, II 41 II 11

Child has birth siblings available for adoption that 

parent(s) did not adopt -- 15 24 PP, II 13 II +

Child has birth sibling(s) also adopted by parent -- 21 36 PP, II 15 II 7

Parent didn’t know if child’s birth siblings ever 

available for adoption -- 10 9 11 9

Parent didn’t know if child has birth siblings -- 14 4 ll 5 ll 43

Child has no known birth siblings -- 15 8 PP, II 15 ll 26

Marital status of child's parents2

Married 71 69 70 PP, II 59 II 82

Cohabiting 8 2 ** + P + +

Single or other 21 29 ** 29 PP, II 38 II 16

Child lives with married adoptive parents -- 60 59 II 52 II 73

Family structure

Two married adoptive parents, also married at adoption -- 55 53 II 47 II 70

Two married adoptive parents, not married at adoption -- 5 6 I 5 +

Two non-married adoptive parents in household -- 1+++

Only one adoptive parent in household -- 39 40 II 47 ll 26

Number of children under 18 in household

One 23 38 ** 27 PP, II 48 II 37

Two 39 37 32 II 36 II 47

Three 27 15 ** 24 PP, II 9 10

Four or more 11 10 16 PP, II 7 +

Birth and adoptive children in family

Focal (adopted) child is only child in family -- 19 11 PP, II 24 23

Child has sibling(s) who are adopted and none who were -- 30 27 II 22 II 48

born to parent

Child has siblings(s) born to parent and no adopted siblings -- 26 22 PP 33 II 19

Child has adopted sibling(s) and sibling(s) born to parent -- 25 40 PP, II 21 II 10

1 Adopted children were defined as those with at least one adoptive parent, but no biological parents, in the household.

2 For children with two parents, the second parent may or may not have adopted the child.

P Significantly different from the estimate for children adopted from private domestic sources (P: p<.10, PP: p<.05).

I Significantly different from the estimate for children adopted internationally (I: p<.10, II: p<.05).

+ The relative standard error exceeds 0.30.

— Not applicable.

NOTE: Percentages may not sum to 100 in percent distributions within categories due to rounding.

SOURCE: 2007 National Survey of Adoptive Parents.

All 

adopted

children1

Foster

care

Private

domestic

International

Type of adoption

All 

children
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 63

Table 6. Percentage distribution of children ages 0-17 by neighborhood characteristics, 

by adoptive status and adoption type: United States, 2007

Neighborhood characteristics

Percent Percent Percent Percent Percent

Child lives in a Metropolitan Statistical Area2 78 76 75 76 79

Child lives in a safe neighborhood 71 79 ** 77 79 83

Child lives in a neighborhood with no amenities3 544 II + II +

Child lives in a neighborhood with no characteristics 

of poor physical condition4 71 75 * 74 73 80

1 Adopted children were defined as those with at least one adoptive parent, but no biological parents, in the household.

2 On the NSCH file, the MSA status was suppressed for children in states in which either the sum total population for all MSAs, or 

the sum total population for all non-MSAs, was less than 500,000 persons. Among these children, we assumed that children living 

in primarily urban states were living in MSAs and that children living in other states were not living in MSAs. 3 Amenities include 1) sidewalks or walking paths, 2) a park or playground area, 3) a recreation center, community center, or boys’

or girls’ club, and 4) a library or bookmobile.

4 Characteristics of poor physical condition include 1) litter or garbage, 2) poorly kept or dilapidated housing, and 3) vandalism.

* Significantly different from the estimate for all children (*: p<.10, **: p<.05). P Significantly different from the estimate for children adopted from private domestic sources (P: p<.10, PP: p<.05).

I Significantly different from the estimate for children adopted internationally (I: p<.10, II: p<.05).

+ The relative standard error exceeds 0.30.

SOURCE: 2007 National Survey of Children's Health and 2007 National Survey of Adoptive Parents.

All 

adopted

children1

Foster

care

Private

domestic

International

Type of adoption

All 

children
64 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

Table 7. Percentage distribution of children ages 0-17 by physical health and factors related to

health, by adoptive status and adoption type: United States, 2007

Physical Health and factors related to health

Percent Percent Percent Percent Percent

Child's health status is excellent or very good

Among all children 84 85 81 II 84 II 93

By child's current age

Among children ages 0-5 87 90 78 II 89 I 98

Among children ages 6-11 84 87 87 82 94

Among children ages 12-17 83 81 78 84 84

Child has special health care needs

Among all children 19 39 ** 54 PP, II 32 29

By child's current age

Among children ages 0-5 12 22 ** 39 II 25 II 10

Among children ages 6-11 22 44 ** 59 PP, II 35 33

Among children ages 12-17 23 43 ** 52 PP 33 I 48

Missed > 10 school days due to illness/injury (Ages 6+)

Among all children 6778+

By child's current age

Among children ages 6-11 5 7+++

Among children ages 12-17 7 7+++

Child has moderate or severe health difficulties

Among all children

Moderate or severe health problem(s) 10 26 ** 39 PP, II 21 I 14

Mild current condition or non-current condition 21 26 ** 28 25 24

Never diagnosed with a chronic condition 69 48 ** 33 PP, II 54 I 62

By child's current age

Among children ages 0-5

Moderate or severe health problem(s) 5 11 ** 26 P, II + II +

Mild current condition or non-current condition 12 14 + + 14

Never diagnosed with a chronic condition 83 74 ** 57 P, II 75 83

Among children ages 6-11

Moderate or severe health problem(s) 12 29 ** 43 PP, II 21 17

Mild current condition or non-current condition 23 26 31 24 23

Never diagnosed with a chronic condition 65 45 ** 26 PP, II 56 60

Among children ages 12-17

Moderate or severe health problem(s) 14 30 ** 38 P 24 27

Mild current condition or non-current condition 28 31 27 31 40

Never diagnosed with a chronic condition 59 39 ** 34 45 34

Child is impacted by asthma

Among all children

Never diagnosed with asthma 87 81 ** 76 PP, II 83 86

No longer has asthma, or asthma is mild 11 15 ** 20 PP, II 11 12

Asthma is currently moderate or severe 3 4 * 5 6 I +

By child's current age

Among children ages 0-5

Never diagnosed with asthma 91 85 ** 76 II 83 92

No longer has asthma, or asthma is mild 7 9+++

Asthma is currently moderate or severe 2 6 ** + II + II +

Among children ages 6-11

Never diagnosed with asthma 85 82 77 85 86

No longer has asthma, or asthma is mild 12 15 17 13 +

Asthma is currently moderate or severe 3++++

Among children ages 12-17

Never diagnosed with asthma 84 79 * 75 82 79

No longer has asthma, or asthma is mild 13 17 23 12 +

Asthma is currently moderate or severe 3++++

All 

adopted

children1

Foster

care

Private

domestic

International

Type of adoption

All 

children
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 65

Table 7. Percentage distribution of children ages 0-17 by physical health and factors related to

health, by adoptive status and adoption type: United States, 2007. 

Continued.

Physical Health and factors related to health

Percent Percent Percent Percent Percent

Child was injured and required medical attention during 

the last 12 months (Ages 0-5) 10 14 18 + 13

Child's health insurance coverage

Among all children

No health insurance 9 5 ** +6+

Public health insurance 29 36 ** 59 PP, II 33 II +

Some other type of health insurance 62 60 37 PP, II 61 II 92

By child's current age

Among children ages 0-5

No health insurance 8 4 ** +++

Public health insurance 35 22 ** 66 PP, II + II +

Some other type of health insurance 57 74 ** 33 PP, II 76 II 94

Among children ages 6-11

No health insurance 10 + ** + + I +

Public health insurance 28 39 ** 66 PP, II 35 II +

Some other type of health insurance 62 57 31 PP, II 56 II 94

Among children ages 12-17

No health insurance 10 6 ** +5+

Public health insurance 24 38 ** 52 PP, II 37 II +

Some other type of health insurance 66 56 ** 43 PP, II 58 II 84

Child's insurance status now and over past 12 months

Among all children

Consistently insured over past 12 months 85 91 ** 94 P 88 91

Currently insured but without insurance sometime

in past 12 months 64+ P 6 +

Not currently insured but had insurance sometime 

in past 12 months 4 3 ** +3+

No insurance at all in past 12 months 5 2 ** + P + +

Child was consistently insured over past 12 months

By child's current age

Among children ages 0-5 85 93 ** 98 I 94 90

Among children ages 6-11 84 91 ** 95 86 92

Among children ages 12-17 85 90 * 93 86 90

Child has adequate health insurance

Among all children 76 78 80 76 77

By child's current age

Among children ages 0-5 81 83 79 80 86

Among children ages 6-11 75 78 87 PP, II 74 68

Among children ages 12-17 74 76 74 76 80

Child receives coordinated, ongoing, comprehensive care 

within a medical home2

Among all children 58 60 58 I 58 I 67

By child's current age

Among children ages 0-5 64 68 56 68 73

Among children ages 6-11 55 64 ** 68 57 68

Among children ages 12-17 53 54 50 55 59

1 Adopted children were defined as those with at least one adoptive parent, but no biological parents, in the household.

2 Components of a medical home include: 1) Has a usual source for sick care, 2) Has a personal doctor or nurse, 3) Has no problems 

obtaining referrals when needed, 4) Receives effective care coordination, and 5) Receives family-centered care (1+ visits in past year). * Significantly different from the estimate for all children (*: p<.10, **: p<.05).

P Significantly different from the estimate for children adopted from private domestic sources (P: p<.10, PP: p<.05).

I Significantly different from the estimate for children adopted internationally (I: p<.10, II: p<.05).

+ The relative standard error exceeds 0.30.

NOTE: Percentages may not sum to 100 in percent distributions within categories due to rounding.

SOURCE: 2007 National Survey of Children's Health and 2007 National Survey of Adoptive Parents.

All 

adopted

children1

Foster

care

Private

domestic

International

Type of adoption

All 

children
66 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

Table 8. Percentage distribution of children ages 0-17 by social and emotional well-being, by

adoptive status and adoption type: United States, 2007

Social and emotional well-being

Percent Percent Percent Percent Percent

Child has been diagnosed with attachment disorder

Among all children ages 0-17 -- 12 21 PP, II 6 8

By child's current age

Among children ages 6-11 -- 12 20 PP, II + +

Among children ages 12-17 -- 16 24 PP + I +

Child has been diagnosed with depression (Age 2+)

Among all children ages 2+

Child never diagnosed with condition 96 91 ** 90 90 94

No longer has condition, or condition is mild 3 7 ** 86+

Condition is currently moderate or severe 1 2 * +++

By child's current age

Among children ages 12-17

Child never diagnosed with condition 93 82 ** 83 83 79

No longer has condition, or condition is mild 5 13 ** 12 12 +

Condition is currently moderate or severe 2 5 * +++

Child has been diagnosed with ADD/ADHD (Age 6+)

Among all children ages 6+

Child never diagnosed with condition 90 74 ** 62 PP, II 81 83

No longer has condition, or condition is mild 6 12 ** 17 PP, II 9 +

Condition is currently moderate or severe 4 14 ** 20 PP, II 10 9

By child's current age

Among children ages 6-11

Child never diagnosed with condition 91 79 ** 68 PP, II 85 88

No longer has condition, or condition is mild 5 10 ** 16 PP + +

Condition is currently moderate or severe 4 11 ** 16 II + +

Among children ages 12-17

Child never diagnosed with condition 88 69 ** 57 PP, II 78 75

No longer has condition, or condition is mild 8 14 ** 19 P, I 11 +

Condition is currently moderate or severe 4 17 ** 24 PP 11 +

Child has been diagnosed with behavior or conduct problems (Age 2+)

Among all children ages 2+

Child never diagnosed with condition 96 85 ** 75 PP, II 89 93

No longer has condition, or condition is mild 2 8 ** 11 P, II 6 +

Condition is currently moderate or severe 2 8 ** 14 PP, II 5 +

By child's current age

Among children ages 6-11

Child never diagnosed with condition 95 90 ** 82 P, II 91 II 99

No longer has condition, or condition is mild 2 5 * + II + I +

Condition is currently moderate or severe 35+ II + II +

Among children ages 12-17

Child never diagnosed with condition 94 76 ** 66 PP, I 85 80

No longer has condition, or condition is mild 3 11 ** 14 + +

Condition is currently moderate or severe 3 13 ** 20 PP + +

Child has problems with social behaviors (Age 6+)

Among all children ages 6-17 9 14 ** 18 P 10 +

By child's current age

Among children ages 6-11 8 9 16 PP, II + +

Among children ages 12-17 9 18 ** 19 15 +

All 

adopted

children1

Foster

care

Private

domestic

International

Type of adoption

All 

children
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 67

Table 8. Percentage distribution of children ages 0-17 by social and emotional well-being, 

by adoptive status and adoption type: United States, 2007. 

Continued.

Social and emotional well-being

Percent Percent Percent Percent Percent

Child exhibits positive social behaviors (Age 6+)

Among all children ages 6-17 94 88 ** 83 P 91 89

By child's current age

Among children ages 6-11 94 90 * 86 92 93

Among children ages 12-17 93 86 ** 81 91 83

1 Adopted children were defined as those with at least one adoptive parent, but no biological parents, in the household.

* Significantly different from the estimate for all children (*: p<.10, **: p<.05).

P Significantly different from the estimate for children adopted from private domestic sources (P: p<.10, PP: p<.05).

I Significantly different from the estimate for children adopted internationally (I: p<.10, II: p<.05).

+ The relative standard error exceeds 0.30.

— Not applicable or not available.

NOTE: Percentages may not sum to 100 in percent distributions within categories due to rounding.

SOURCE: 2007 National Survey of Children's Health and 2007 National Survey of Adoptive Parents.

All 

adopted

children1

Foster

care

Private

domestic

International

Type of adoption

All 

children
68 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

Table 9. Percentage distributions of children ages 5-17 by cognitive development and

educational achievement, by adoptive status and adoption type: United States, 2007

Cognitive development and educational attainment

Percent Percent Percent Percent Percent

Child has excellent or very good reading/language arts performance (Ages 5+)

Among all children -- 58 50 PP, II 64 63

By child's current age

Among children ages 5-11 -- 66 55 PP, II 71 74

Among children ages 12-17 -- 50 45 P 58 I 41

Child has excellent or very good math performance (Ages 5+)

Among all children -- 53 41 PP, II 58 65

By child's current age

Among children ages 5-11 -- 64 50 PP, II 67 II 79

Among children ages 12-17 -- 42 32 PP 51 39

Child usually/always engaged in school (Ages 6+)

Among all children 81 69 ** 61 PP, II 74 73

By child's current age

Among children ages 6-11 86 80 * 73 P 86 83

Among children ages 12-17 75 58 ** 50 P 66 58

Child spends any time reading for pleasure on an 

average school day (Ages 6+)

Among all children 84 79 * 80 78 81

By child's current age

Among children ages 6-11 89 88 90 87 86

Among children ages 12-17 78 71 ** 70 72 72

1 Adopted children were defined as those with at least one adoptive parent, but no biological parents, in the household.

* Significantly different from the estimate for all children (*: p<.10, **: p<.05).

P Significantly different from the estimate for children adopted from private domestic sources (P: p<.10, PP: p<.05).

I Significantly different from the estimate for children adopted internationally (I: p<.10, II: p<.05). — Not applicable or not available.

SOURCE: 2007 National Survey of Children's Health and 2007 National Survey of Adoptive Parents.

All 

adopted

children1

Foster

care

Private

domestic

International

Type of adoption

All 

children
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 69

Table 10. Percentage distributions of children ages 0-17 by family and community activities

and context, by adoptive status and adoption type: United States, 2007

Cognitive development and educational attainment

Percent Percent Percent Percent Percent

Child is read to every day (Ages 0-5) 48 68 ** 66 73 65

Child is sung to or told stories every day (Ages 0-5) 59 73 ** 68 75 74

Family eats meals together 6-7 days per week 52 56 * 54 II 52 II 64

Child participates in one or more organized activities outside 

of school, such as sports teams or lessons, clubs, or religious 

groups (Ages 6+)

Among all children 81 85 ** 81 II 85 II 93

By child's current age

Ages 6-11 79 89 ** 84 II 90 II 97

Ages 12-17 82 81 78 81 87

Child has been involved in any type of community service or 

volunteer work at school, church, or in the community during 

the past 12 months (Ages 12+) 78 83 85 82 78

Child attends religious services at least monthly

Among all children 70 78 ** 87 PP, II 77 II 66

By child's current age

Ages 0-5 63 69 86 PP, II 70 59

Ages 6-11 76 80 86 I 81 72

Ages 12-17 73 80 ** 89 PP, II 77 67

1 Adopted children were defined as those with at least one adoptive parent, but no biological parents, in the household.

* Significantly different from the estimate for all children (*: p<.10, **: p<.05).

P Significantly different from the estimate for children adopted from private domestic sources (P: p<.10, PP: p<.05).

I Significantly different from the estimate for children adopted internationally (I: p<.10, II: p<.05).

NOTE: Percentages may not sum to 100 in percent distributions within categories due to rounding.

SOURCE: 2007 National Survey of Children's Health and 2007 National Survey of Adoptive Parents.

All 

adopted

children1

Foster

care

Private

domestic

International

Type of adoption

All 

children
70 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

Table 11. Percentage distributions of children ages 0-17 by parenting and parent well-being,by

adoptive status and adoption type: United States, 2007

Parenting and parent well-being

Percent Percent Percent Percent Percent

Parent-child relationship very warm/close

Among all children -- 81 75 PP, II 85 85

By child's current age

Among children ages 0-5 -- 97 99 99 95

Among children ages 6-11 -- 87 81 P 93 90

Among children ages 12-17 -- 69 64 74 66

Among children whose parents have a spouse/partner, 

spouse/partner-child relationship very warm/close

Among all children -- 77 68 PP, II 80 83

By child's current age

Among children ages 0-5 -- 97 98 94 98

Among children ages 6-11 -- 79 74 87 81

Among children ages 12-17 -- 61 51 P 70 65

Parent-child relationship, compared to parent's expectations

Among all children

Better than you ever expected -- 42 36 P, II 44 46

About what you expected -- 44 44 45 41

More difficult than you ever expected -- 15 19 PP, I 11 13

By child's current age

Among children ages 0-5

Better than you ever expected -- 63 57 65 64

About what you expected -- 33 37 30 34

More difficult than you ever expected -- ++++

Among children ages 6-11

Better than you ever expected -- 41 39 45 38

About what you expected -- 48 46 49 50

More difficult than you ever expected -- 11 15 + +

Among children ages 12-17

Better than you ever expected -- 33 29 36 36

About what you expected -- 44 44 47 34

More difficult than you ever expected -- 23 27 17 31

Among children whose parents have a spouse/partner, 

spouse/partner-child relationship, compared to expectations

Among all children

Better than you ever expected -- 39 33 45 40

About what you expected -- 46 49 41 47

More difficult than you ever expected -- 15 18 14 14

By child's current age

Among children ages 0-5

Better than you ever expected -- 59 64 65 52

About what you expected -- 39 34 33 47

More difficult than you ever expected -- ++++

Among children ages 6-11

Better than you ever expected -- 38 42 38 33

About what you expected -- 49 49 52 47

More difficult than you ever expected -- 13 +++

Among children ages 12-17

Better than you ever expected -- 27 11 PP, II 39 33

About what you expected -- 46 54 P 38 46

More difficult than you ever expected -- 27 36 I 23 +

All 

adopted

children1

Foster

care

Private

domestic

International

Type of adoption

All 

children
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 71

Table 11. Percentage distributions of children ages 0-17 by parenting and parent well-being,

by adoptive status and adoption type: United States, 2007. 

Continued.

Parenting and parent well-being

Percent Percent Percent Percent Percent

Having child in life, compared to parent's expectations

Among all children

Better than you ever expected -- 51 40 PP, II 54 I 62

About what you expected -- 35 42 II 36 II 24

More difficult than you ever expected -- 13 18 PP 9 14

By child's current age

Among children ages 0-5

Better than you ever expected -- 71 57 76 73

About what you expected -- 26 36 22 23

More difficult than you ever expected -- 4+++

Among children ages 6-11

Better than you ever expected -- 52 42 P, II 56 62

About what you expected -- 37 46 II 37 25

More difficult than you ever expected -- 11 12 + +

Among children ages 12-17

Better than you ever expected -- 41 34 P, I 46 49

About what you expected -- 38 40 II 41 II 23

More difficult than you ever expected -- 21 25 PP 14 I 28

Parent experiences parental aggravation

Among all children 6 11 ** 16 PP, II 7 9

By child's current age

Among children ages 0-5 4++ l + +

Among children ages 6-11 6 9 11 + +

Among children ages 12-17 8 14 ** 19 PP 8 +

Parent copes very well with the demands of parenting

Among all children 60 53 ** 49 58 52

By child's current age

Among children ages 0-5 67 66 68 69 63

Among children ages 6-11 59 53 48 62 50

Among children ages 12-17 55 47 ** 45 52 39

Among children whose parents have a spouse/partner, 

spouse/partner relationship quality

Among all children

Completely happy 35 38 39 42 33

Very happy 48 49 50 47 52

Fairly or not too happy 17 12 ** 11 11 16

1 Adopted children were defined as those with at least one adoptive parent, but no biological parents, in the household.

* Significantly different from the estimate for all children (*: p<.10, **: p<.05).

P Significantly different from the estimate for children adopted from private domestic sources (P: p<.10, PP: p<.05).

I Significantly different from the estimate for children adopted internationally (I: p<.10, II: p<.05).

+ The relative standard error exceeds 0.30.

— Not applicable or not available.

NOTE: Percentages may not sum to 100 in percent distributions within categories due to rounding.

SOURCE: 2007 National Survey of Children's Health and 2007 National Survey of Adoptive Parents.

All 

adopted

children1

Foster

care

Private

domestic

International

Type of adoption

All 

children
72 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

Table 12. Percentage distributions of children ages 0-17 by adoption satisfaction,

by adoption type: United States, 2007.

Adoption satisfaction

Percent Percent Percent Percent

Parent would make same decision to adopt child

Definitely would 87 81 PP, I 93 I 87

Probably would 10 14 PP 6 9

Probably or definitely NOT 3 6 PP + +

Parent considered dissolving the adoption 1+ 2 + PP, I 0+ 0+

Parent's perception of child's feelings about adoption (Ages 5+)

Among all children ages 5-17

Positive 49 47 52 48

Mostly positive 43 46 38 48

Negative, or not positive 889+

By child's current age

Among children ages 5-11

Positive 51 45 59 49

Mostly positive 44 49 34 49

Negative, or not positive 5+++

Among children ages 12-17

Positive 47 48 47 45

Mostly positive 43 43 42 44

Negative, or not positive 10 +++

1 Adopted children were defined as those with at least one adoptive parent, but no biological parents, in the household.

P Significantly different from the estimate for children adopted from private domestic sources (P: p<.10, PP: p<.05).

I Significantly different from the estimate for children adopted internationally (I: p<.10, II: p<.05).

+ The relative standard error exceeds 0.30.

NOTE: Percentages may not sum to 100 in percent distributions within categories due to rounding.

SOURCE: 2007 National Survey of Adoptive Parents.

All 

adopted

children1

Foster

care

Private

domestic

International

Type of adoption
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 73

Table 13. Percentage distribution of children ages 0-17 by parent involvement and advocacy in

the adoption community, by adoption type: United States, 2007

Parent involvement/advocacy in adoption community

Percent Percent Percent Percent

Parent helped other adoptive families

Helped other adoptive families 42 38 II 34 II 60

Was asked, but did not help other adoptive families 3+++

Was not asked to help other adoptive families 56 60 II 64 II 36

Parent recruited other adoptive families

Recruited other adoptive families 6 9 PP, II 4 +

Was asked, but did not recruit other families 2 4 PP + +

Was not asked to recruit other adoptive families 92 87 PP, II 95 95

1 Adopted children were defined as those with at least one adoptive parent, but no biological parents, in the household.

P Significantly different from the estimate for children adopted from private domestic sources (P: p<.10, PP: p<.05).

I Significantly different from the estimate for children adopted internationally (I: p<.10, II: p<.05).

+ The relative standard error exceeds 0.30.

NOTE: Percentages may not sum to 100 in percent distributions within categories due to rounding.

SOURCE: 2007 National Survey of Adoptive Parents.

All 

adopted

children1

Foster

care

Private

domestic

International

Type of adoption
74 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

Table 14. Percentage distribution of children ages 0-17 by parents' prior connections to

adoption, by adoption type: United States, 2007

Parents' prior connections to adoption

Percent Percent Percent Percent

Parent's closest prior connection to adoption

Either parent was adopted 6746

Else, sibling of parent was adopted 443+

Else, other relative(s) of parent was/were adopted 31 30 30 32

Else, friends of parent have adopted 35 33 II 30 II 48

Else, no prior experience with adoption 24 26 P, II 33 II 10

1 Adopted children were defined as those with at least one adoptive parent, but no biological parents, in the household.

P Significantly different from the estimate for children adopted from private domestic sources (P: p<.10, PP: p<.05).

I Significantly different from the estimate for children adopted internationally (I: p<.10, II: p<.05).

+ The relative standard error exceeds 0.30.

SOURCE: 2007 National Survey of Adoptive Parents.

All 

adopted

children1

Foster

care

Private

domestic

International

Type of adoption

Table 15. Percentage distribution of children ages 0-17 by parents' motivation to adopt,

by adoption type: United States, 2007

Motivation to adopt1

Percent Percent Percent Percent

Infertility 52 39 PP, II 52 II 72

Wanted to expand family 69 61 II 60 II 92

Wanted sibling for a child 24 24 PP, II 16 II 36

Had adopted child's sibling 7 11 P, II 7 II +

Wanted to provide a permanent home for a child 81 86 PP 70 II 90

Had already formed a bond/loved the child3 4 9 PP, II + +

Related to child prior to adoption3 7 7 II 11 II +

1 Categories are not mutually exclusive, so categories may sum to more than 100.

2 Adopted children were defined as those with at least one adoptive parent, but no biological parents, in the household.

3 This category is based on verbatim explanations from respondents who reported some "other" reason for adopting.

P Significantly different from the estimate for children adopted from private domestic sources (P: p<.10, PP: p<.05). I Significantly different from the estimate for children adopted internationally (I: p<.10, II: p<.05).

+ The relative standard error exceeds 0.30.

SOURCE: 2007 National Survey of Adoptive Parents.

All 

adopted

children2

Foster

care

Private

domestic

International

Type of adoption
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 75

Table 16. Percentage distributions of children ages 0-17 by parents' satisfaction with their

agency or attorney, by adoption type: United States, 2007

Satisfaction with attorney or agency

Percent Percent Percent Percent

Satisfaction with attorney or agency

Very positive 54 48 PP, I 57 57

Positive 35 36 37 33

Mixed or negative 11 16 PP, II 6 I 10

For parents who fostered prior to adoption, options other 

than adoption were discussed with parent(s) -- 56 -- --

For parents who fostered prior to adoption, parent(s) 

pressure by agency to adopt child -- 6 + -- --

Important information was not disclosed to parent(s) 8 13 4 +

1 Adopted children were defined as those with at least one adoptive parent, but no biological parents, in the household.

P Significantly different from the estimate for children adopted from private domestic sources (P: p<.10, PP: p<.05).

I Significantly different from the estimate for children adopted internationally (I: p<.10, II: p<.05).

+ The relative standard error exceeds 0.30.

— Not applicable.

NOTE: Percentages may not sum to 100 in percent distributions within categories due to rounding.

SOURCE: 2007 National Survey of Adoptive Parents.

All 

adopted

children1

Foster

care

Private

domestic

International

Type of adoption
76 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

Table 17. Percentage distributions of children ages 0-17 by adoption expenses, by adoption

type: United States, 2007

Expenses

Percent Percent Percent Percent

Cost of adoption

No cost -- -- 22 II +

Less than $5,000 -- -- 33 II +

At least $5,000 but less than $10,000 -- -- 13 II 5

At least $10,000 but less than $15,000 -- -- 11 II 19

At least $15,000 but less than $20,000 -- -- 10 II 25

$20,000 or more -- -- 12 II 49

Cost of adoption

Less than $10,000 (includes no cost) -- -- -- 7

At least $10,000 but less than $15,000 -- -- -- 19

At least $15,000 but less than $20,000 -- -- -- 25

At least $20,000 but less than $25,000 -- -- -- 25

At least $25,000 but less than $30,000 -- -- -- 11

At least $30,000 but less than $35,000 -- -- -- 8

$35,000 or more -- -- -- 4

Cost of adoption

Among all children

No cost 29 56 PP, II 22 II +

Less than $5,000 23 29 II 33 II +

At least $5,000 but less than $10,000 9 6 PP 13 II 5

$10,000 or more 39 9 PP, II 33 II 93

By relative/non-relative adoptive status

Among children adopted by relatives

No cost 53 65 PP 46 77

Less than $5,000 42 31 PP 48 +

$5,000 or more 5+++

Among children adopted by non-relatives

No cost 22 54 PP, II 5 II +

Less than $5,000 17 28 II 22 II +

$5,000 or more 61 19 PP, II 73 II 99

Filed for federal adoption tax credit2 80 66 PP, II 84 86

Agency reimbursed some or all of cost -- 39 -- --

Employer provided financial assistance 13 6 PP, II 13 II 22

1 Adopted children were defined as those with at least one adoptive parent, but no biological parents, in the household.

2 Children whose adoptions occurred prior to 1997, before the tax credit was available, are excluded from this analysis.

P Significantly different from the estimate for children adopted from private domestic sources (P: p<.10, PP: p<.05).

I Significantly different from the estimate for children adopted internationally (I: p<.10, II: p<.05).

+ The relative standard error exceeds 0.30.

— Not applicable or not available.

NOTE: Percentages may not sum to 100 in percent distributions within categories due to rounding.

SOURCE: 2007 National Survey of Adoptive Parents.

All 

adopted

children1

Foster

care

Private

domestic

International

Type of adoption
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 77

Table 18. Percentage distributions of children ages 0-17 adoption openness, 

by adoption type: United States, 2007

Openness of adoption

Percent Percent Percent Percent

Child knows he/she is adopted (Age 5+) 97 94 PP, II 98 II 100

Pre-adoption agreement regarding openness 

(non-relative adoptions only)2 32 32 PP, II 67 II +

Any post-adoption contact with birth family 

(non-relative adoptions only)2 36 39 PP, II 68 II 6

1 Adopted children were defined as those with at least one adoptive parent, but no biological parents, in the household.

2 Parents who were related to the child prior to the adoption were not asked questions about pre-adoption agreements 

regarding openness or about post adoption contact with the child's birth family.

P Significantly different from the estimate for children adopted from private domestic sources (P: p<.10, PP: p<.05). I Significantly different from the estimate for children adopted internationally (I: p<.10, II: p<.05).

+ The relative standard error exceeds 0.30.

NOTE: Percentages may not sum to 100 in percent distributions within categories due to rounding.

SOURCE: 2007 National Survey of Adoptive Parents.

All 

adopted

children1

Foster

care

Private

domestic

International

Type of adoption
78 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents

Table 19. Percentage distributions of children ages 0-17 by receipt of post-adoption services

and supports, by adoption type: United States, 2007

Post-adoption services

Percent Percent Percent Percent

Supports specific to adoption:

Met with someone at agency to discuss post-adoption services

Received service 35 36 PP,II 25 II 50

Did not receive service, but wanted to 7 9 I 5 +

Did not receive and did not want service 58 56 PP,II 69 II 45

Child support group (Ages 5+)

Received service 11 10 II 8 II 19

Did not receive service, but wanted to 16 17 13 19

Did not receive and did not want service 73 73 I 80 II 63

Parent support group

Received service 31 29 I 26 I 38

Did not receive service, but wanted to 11 13 11 9

Did not receive and did not want service 58 57 63 I 52

Training for parent

Received service 31 38 PP, I 25 29

Did not receive service, but wanted to 12 12 10 15

Did not receive and did not want service 57 51 PP 65 II 56

At least one needed adoption-specific support was not

received post-adoption2 30 35 27 29

Additional adoption-specific supports:

Use of web-based resources 30 24 ll 21 ll 53

Financial supports for adoption:

Adoption agreement: Medicaid/health insurance

Has adoption agreement including Medicaid AND subsidy -- 64 -- --

Has adoption agreement not including both of these -- 28 -- --

Does not have adoption agreement -- 8 -- --

Receipt of adoption subsidy

Never received a subsidy -- 21 -- --

Ever received a subsidy, but not currently -- + -- --

Currently receives a subsidy -- 78 -- --

Rehabilitative services:3

At least one rehabilitative service was received

Among all children 37 46 PP,II 34 29

By child's current age

Among children ages 0-5 9 19 PP,II 5+ 6+

Among children ages 5-11 33 39 27 32

Among children ages 12-17 54 60 49 55

Family counseling

Received service 20 23 19 17

Did not receive service, but wanted to 6 9 PP 4 +

Did not receive and did not want service 74 69 PP,II 78 78

All 

adopted

children1

Foster

care

Private

domestic

International

Type of adoption
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 79

Table 19. Percentage distributions of children ages 0-17 by receipt of post-adoption services

and supports, by adoption type: United States, 2007. Continued.

Post-adoption services

Percent Percent Percent Percent

Crisis counseling

Received service 3 6 PP, II + +

Did not receive service, but wanted to 3 + I + +

Did not receive and did not want service 94 90 PP, II 96 97

Mental health care for child (Ages 5+)

Received service 39 46 P, I 33 35

Did not receive service, but wanted to 4+3+

Did not receive and did not want service 58 50 P, I 64 60

Child received mental health care service(s) (Ages 5+)

By child's current age

Among children ages 5-11 27 34 20 25

Among children ages 12-17 50 57 P 43 53

Psychiatric residential treatment/hospitalization 

for the child (Ages 8+)

Received service 4 7 I + +

Did not receive service, but wanted to + + PP + I +

Did not receive and did not want service 94 90 PP 97 95

Child received psychiatric residential treatment/hospitalization (Ages 14+) 8+++

Child received drug/alcohol services (Ages 13+)

Received service 4+++

Did not receive service, but wanted to ++++

Did not receive and did not want service 95 94 96 96

Other services:

Had a mentor (Ages 5+)

Received service 13 18 II 13 II 7

Did not receive service, but wanted to 11 14 I 10 +

Did not receive and did not want service 76 68 PP, II 77 I 85

Had a tutor (Ages 5+)

Received service 36 39 32 36

Did not receive service, but wanted to 11 12 12 8

Did not receive and did not want service 53 49 55 56

At least one needed support not specific to adoption was 

not received post-adoption4 21 26 II 21 16

1 Adopted children were defined as those with at least one adoptive parent, but no biological parents, in the household.

2 Including having met with someone to discuss supports, support groups for children or parents, and parent training.

3 Including family counseling, crisis counseling, child mental health care, child residential treatment, and child drug/alcohol services.

4 Including family counseling, crisis counseling, child mental health care, child residential treatment, child drug/alcohol services, 

mentor, and tutor. Significantly different from the estimate for all adopted children (*: p<.10, **: p<.05).

P Significantly different from the estimate for children adopted from private domestic sources (P: p<.10, PP: p<.05).

I Significantly different from the estimate for children adopted internationally (I: p<.10, II: p<.05).

+ The relative standard error exceeds 0.30.

— Not applicable.

NOTE: Percentages may not sum to 100 in percent distributions within categories due to rounding.

SOURCE: 2007 National Survey of Adoptive Parents.

All 

adopted

children1

Foster

care

Private

domestic

International

Type of adoption
80 Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents
Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents 81