Journal Issue: Adoption Volume 3 Number 1 Spring 1993
Discussion
The difficulties of research on prenatal drug exposure are great.12 At this time, this study cannot answer fundamental questions about what would happen to drug-exposed children given the enriched environments typical of adoptive homes. The research does not specify precisely whether drug exposure had occurred or to what extent. Some parents deduce perinatal drug exposure when their children are not acting as they had hoped or expected. The research did not query parents or social workers about how they knew what they said that they knew. There is particular reason for concern that the older children identified as drug-exposed may have been labeled this way in a post hoc fashion, as there was less testing and recording of perinatal drug exposure prior to 1987. Still, we cannot rule out the possibility that exposure to cocaine or heroin did occur earlier. Indeed, selection into the drug-exposed group required that parents indicate knowledge of drug exposure before the placement.
What is remarkable about this study is its failure to find statistically significant differences between presumably different groups. When expected differences are not found, researchers cannot simply conclude from their results that the groups are, in fact, similar. Instead, they must search for alternative explanations and question their methods. They must ask if the sample size was too small, if the sample was somehow biased, or if the measurement was weak.
The sample size for this study was the largest by far of any reported adoption study. Although responses were not available from the entire sample of adoptive families or even from the entire sample of parents asked to participate in the study, it can be argued that the 65% response rate yielded an adequate sampling of parents' perceptions. Thus, although some groups may have been underrepresented in the sample and some problems may exist with the anecdotal ways in which drug exposure was determined, child behavior was measured, and satisfaction was reported, the methods used in this study appear to be reliable, the results of this study appear to be valid, and the conclusions that can be drawn from it deserve consideration.
On almost all indicators of satisfaction, parents of drug-exposed children were highly satisfied and equally as satisfied as parents who adopted non-drug-exposed children. Only one small difference in satisfaction emerged: couples adopting independently had somewhat lower satisfaction if they adopted a drug-exposed child. Overall, the ideas that drug-exposed children are significantly different from non-drug-exposed children and that adopting them is less satisfying receives no support in these data.
Adoptive parents of children whose degree of drug exposure was unknown expected the easiest time of all in caring for their children. They may have been less likely to expect a hard time because their children were adopted at a younger age than the non-drug-exposed group and because they did not have convincing evidence that their child was born drug-exposed. Only time will tell whether they are right and whether adopting a young child with uncertain drug exposure is easier than adopting an older child of any type or a drug-exposed child of any age.
Parents of drug-exposed children also indicated that they were better prepared than parents of non-drug-exposed children. The reasons for their increased preparation are not clear. It may result, however, from the greater likelihood of adopting drug-exposed children after providing foster care to them. This preparation may have helped offset initial effects of uncertainty about their children's future. Many foster parent adoptions involved drug-exposed children. These parents know their children very well. If they were fearful of the uncertainties of adoption, they would probably have retained the less committed status of foster parents. Their commitment speaks well of their children and of their positive expectations for them.
Adoption of drug-exposed children appears to save money. A recent Oregon study of 11 children born drug-exposed in 1986 and subsequently adopted revealed total costs of $39,000 per child for casework, foster care, medical expenses, and adoption and legal costs over a 4-year period (i.e., $9,750 per year).13 The $39,000 in adoption-related costs is roughly equivalent to 18 months of residential drug treatment programs for women and children together. The adoption of these children is estimated to save the agency a minimum of $50,000 over the cost of long-term foster care.14 Our findings indicate that adoption assistance payments are nearly $3,000 less per year than the amount foster families were given to care for the same children. These savings are increased because of the low administrative costs of adoption subsidies (i.e., there are no social worker visits or court reviews). Overall savings may exceed $5,000 per year or nearly $100,000 per child over the duration of their minority years. Savings across the child's lifetime would be still greater. Adoption service programs and adoption assistance payments will pay rich dividends and deserve greater support.
That drug-exposed children look similar to non-drug-exposed children and that their parents' experience is roughly equivalent should be understood by adoption social workers. This does not deny the challenges of adopting a drug-exposed child, but it does indicate that those challenges can generally be met.
The information from this study provides a contrast to journalistic appraisals based on interviews with families most dissatisfied with their adoptions.6 Although potential adoptive parents may be concerned that a high percentage of children available for adoption have been drug-exposed, the mitigating news is that these children and the experiences of their parents do not appear to be significantly different from the norm. The more fragile health of the children and the uncertainty about their developmental future makes them more like special needs adoptions than traditional newborn adoptions. At this point, however, it appears that many drug-exposed children who are adopted do not require substantial special services. This is consistent with the evidence that drug-exposed children can find academic success without formal special educational services.15
This initial success of drug-exposed children does not minimize the importance of making ongoing services available as needed. Although parents reported faring very well in satisfaction, they may need additional resources, like many other adoptive parents, as their children grow and mature. The findings of this study reaffirm the robustness of adoption. The drug epidemic should serve as an impetus for boosting services to all adoptive parents and their children.
