Adoption and Medical History

It is estimated that adoption affects the lives of forty million Americans. This is startling, considering that there are approximately five million adoptees in this country. However, there are birthparents, adoptive parents, birth and adopted siblings, grandparents and a whole array of extended family members who are impacted by adoption. Adoption is becoming more prevalent in the 1990's.

Adoption has the potential of being a very positive way to create a family. One must remember, however, that there are feelings about having surrendered a child to adoption, about having a child -- especially when one cannot bear birthchildren -- and about being adopted that pose special concerns for those involved throughout their lives.

In my research and practice I explore the special issues and concerns that birthparents, adoptive parents and adoptees face. There are normal crises that occur. While all families and individuals go through developmental stages, the special circumstances that adoption creates add issues and complexity to the process of development. These issues are normal and healthy under the circumstances that surrender and adoption create. A systemic approach is needed in order to work with adoptive family systems. There is no identified patient in this model, but the whole system (from the wider context of adoption practices to the intricate relationships in the adoptive family and the birth family) is regarded as the client. Crises can be normal and can even lead to transformation. And when speaking of the adoptive family, the birthparents are included, whether or not they are known.

There are ongoing issues in adoption for the whole family: how to tell the child, what to tell the child, when to tell the child, how to deal with extended family members and neighbors, how to work with the schools and with professionals who have little or no experience with learning disabilities, attention deficit disorder and emotional difficulties in adopted children. Things that birthfamilies take for granted may pose serious dilemmas for adoptive families.

One example is medical history. Physicians say that dealing with an adoptee is like dealing with a coma victim in the sense that critical and current family history information is often missing and impossible to get. For this reason I have come to recommend leaving at least a channel open in all adoptions for the updating of medical information. Even where a "closed adoption" is desired, it is good to have a method for the birthparents to notify the adoption agency when family medical information changes, so that if the adoptee or the adoptive family needs this information there is a possibility of obtaining it.

There are also issues regarding the adoptee as parent, the birthparents' future parenting, the complexities (and concrete possibilities) of open adoption, the myriad reproductive technologies and the issues of adoption that are present for generations, as we look at family histories through genograms with a family systems approach.

Adoption is an ongoing issue through the lifecycle and beyond, affecting not only the generations past but those to come as well. With empathy and understanding, there is opportunity for the empowerment of individuals and families affected by the issues of adoption.

Adapted from "Normative Crises in the Development of the Adoptive Family: A Model for Professionals Working with Adoptive Families" by Joyce Maguire Pavao, Ed.D., as published in the Journal of Marriage and Family Therapy. Reprinted with permission. Dr. Pavao, an adoptee herself, founded and heads PACT (Pre- and Post Adoption Consulting Team), 385 Highland Avenue, Somerville, MA 02144 (617) 628-8815.

As published in the June 1994 VHLFF, 2:2. For permission to reprint, please contact the VHL Family Alliance, editor@vhl.org. Further information is available from the VHL Family Alliance, info@vhl.org