With the support of The Robert Wood Johnson Foundation, The Evan B. Donaldson Adoption Institute convened a two-day conference on October 24-25, 1997 in Alexandria, Virginia entitled Adoption and Prenatal Alcohol and Drug Exposure: The Research, Policy and Practice Challenges. The symposium featured presenters who represented the leading researchers, practitioners, and policy makers in the fields of prenatal substance abuse and adoption. Focusing on the adoption of children who have been prenatally exposed to drugs or alcohol and particularly the short and long term impact of exposure on adopted children, the conference attracted more than 150 professionals, including adoption practitioners as well as health care, mental health, legal and other professionals working in the area of adoption.

The plenary sessions and workshops provided participants with:

• A review of existing research by leading researchers in the field: Dr. Ira Chasnoff, Dr. Barry Zuckerman, Dr. Claire Coles, Dr. Heather Carmichael Olson, and Dr. Richard Barth;
• A consideration of current research-based knowledge on the effects of prenatal substance abuse in the context of adoption: Dr. Robert Hill, Dr. Remi Cadoret, Dr. Joyce Maguire Pavao, and Dr. Mary Dozier;
• An exploration of the policy and practice challenges of prenatal alcohol and drug exposure for adoption services: Dr. Jane Ellen Aronson, Judith Kleinfeld, Joan Hollinger, Judith Larsen, Laura Feig, and Lois Melina;
• Suggested applications of research and practice based knowledge to the provision of services to children and families of color: Elba Montalvo, James Cadwell, and Mark Johnston; and
• A review of effective programmatic approaches to the preparation of adoptive families, interventions to maximize children’s health and development, and support for families and children presented by leading practitioners: Sue Edelstein, Ellen Franck, and Janice Goldwater.

0. The incidence of prenatal alcohol and drug exposure is imprecise at best. Existing data and reports from the field suggest that prenatal exposure continues to have a significant impact on large numbers of children, including those children who are adopted from other countries.
1. The effects of prenatal alcohol and drug exposure are well understood in general; however, the effects on an individual child vary greatly from one child to another.
2. The effects of prenatal alcohol and drug exposure on an infant and the child’s long term development depend not only on the prenatal exposure but on factors related to the child’s own biological vulnerability and, importantly, environmental factors.
3. The effects of prenatal alcohol and drug exposure vary significantly: from severe effects to no impact on developmental outcomes.
4. The outcomes for children who are prenatally exposed depend on the dynamic interaction of the child and the social environment. Positive outcomes are optimized by favorable care-giving environments.
5. There has been very little research on the outcomes for children who are prenatally substance exposed and then adopted. The existing research by Orny and colleagues and Barth and colleagues suggests that prenatally exposed children who are adopted generally fare well developmentally.
6. Research on such issues as genetic versus environmental influences and attachment provides some guidance in anticipating the needs of prenatally substance exposed children who are adopted. Cadoret’s research suggests a greater risk of alcoholism among adoptees whose birth families were alcohol-involved. Dozier’s research suggests that age at time of placement and sensitivity of caregivers are important factors in a child’s ability to attach to a new family.

For all types of adoption – the adoption of children in foster care, the adoption of infants and young children in the United States, and international adoption – practice should incorporate:

0. Sound information gathering from the birth family regarding health and other background, including high risk factors that suggest the use of alcohol or drugs during pregnancy.
1. Assessment of the child to determine any health or development problems associated with prenatal alcohol or drug exposure.
2. Preparation of adoptive families regarding the uncertainties of adoption in general and specifically adoption of children who have been prenatally exposed to alcohol or drugs; assistance to the family in deciding whether adoption of a prenatally substance exposed child is appropriate for them; and communication of all known information about a child whom they are considering for adoption.
3. Ongoing support of adoptive families and children that includes subsidy and/or medical assistance, services designed to meet the child’s health and developmental needs, support and education for the family, and advocacy.
4. Professional development that includes knowledge building about the effects of prenatal alcohol and drug exposure, skills in working with other disciplines to respond effectively to the needs of the child and family, and skills in working with all members of the triad [birth families, children, adoptive parents] as well as with foster parents and extended family.

A publication as a follow-up to the conference is being developed with the partial support of the Robert Wood Johnson Foundation. Edited by Richard P. Barth, Ph.D., David M. Brodzinsky, Ph.D. and Madelyn Freundlich, MSW, J.D., LL.M., the publication will have three parts.

Part I will concentrate on research issues, with contributions from:

• Remi Cadoret, MD, University of Iowa Medical School, "Genetics and the prenatal environment: Factors affecting adoptee outcome"
  
  
• Richard Barth, Ph.D., University of California, Berkeley, "Outcomes for drug exposed children: Eight years after"
  
  
• Robert Hill, Ph.D., Morgan State University, Baltimore, Maryland, "Adoption research: Cultural dimensions"; and
  
  
• Heather Carmichael Olson, Ph.D., University of Washington, "A long term view of fetal alcohol effects: Diagnosis, intervention, and implications for adoption".
  
  

  Part II will address practice issues, with contributions from:

• Susan Edelstein, MSW, University of California, Los Angeles, "TIES for adoption: A model to support the adoption of children who were prenatally exposed to alcohol and other drugs";
  
  
• Jane Ellen Aronson, D.O., Winthrop Pediatrics Association, Minneola, NY, "Prenatal drug and alcohol exposure in internationally adopted children: Can we predict the future?";
  
  
• Joyce McGuire Pavao, Ph.D., Private Practice, Cambridge, MA, "The importance of community support and education for adoptive families with challenging issues"; and
  
  
• Mary Dozier, Ph.D., University of Delaware, "Attachment issues for young children in foster care and implications for adoption of children who are substance exposed".
  
  

  Part III will address policy issues with contributions from:

• Stephan Kandall, M.D., Beth Israel Medical Center, "Societal attitudes towards drug-using women and their children: Past and present";
  
  
• Joan Hollinger, J.D., M.A., University of California School of Law, Berkeley, "Openness and adoptive family autonomy: Implications for adoption law and practice"; and
  
  
• Judith Larsen, J.D., Private Practice, McLean, VA, "Legal and policy barriers to the adoption of drug-affected infants".
  
  

  A concluding chapter, authored by the editors, will address "Issues in the adoption of children prenatally exposed to alcohol and drugs: A look to the future."

  The volume will be published by the Child Welfare League of America Press.

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PROFESSIONAL EDUCATION
PRENATAL SUBSTANCE EXPOSURE

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