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The Risks of Simultaneous Multiple Placements in Intercountry Adoption Practice

Adoption Advocate No. 100


Since the mid-1940s, the practice of adopting orphaned children internationally has experienced peaks as well as periods of decline, driven in part by public interest, world wars, changing regulations and oversight, and politics. Reaching its height in numbers in the early 2000s, with more than 20,000 children adopted from abroad each year, intercountry adoption has been on the decline since its peak in 2004. The number of annual adoptions into the United States dropped to 5,647 in 2015.1 With intercountry adoptions becoming more difficult to obtain, timelines for adoptive families lengthening, and the age range of available children widening, agencies are increasingly met with requests from families wanting to adopt more than one child at a time, adopt children who may be out of birth order with existing children, or adopt children close in age with existing children (often referred to as “artificial twinning”).

While some might look at the situation for many orphaned and institutionalized children and consider these simple, reasonable requests to grant, the reality is far more complex. Regardless of intent, adoption cannot benefit children when they do not thrive in their adoptive homes—and this sad outcome is doubly regrettable when contributing factors, such as the increased stress often caused by multiple unrelated child placements, could have been avoided.

This article seeks to examine the risks and implications of multiple simultaneous adoptions into one family, the ethics surrounding these decisions, and current best practices in this area.

The Current Landscape of Intercountry Adoption

In 2015, just 6% of intercountry adoptions were infants, and 72% of intercountry adoptions were children over the age of three. Perhaps most telling is that 13% of intercountry adoptions in 2015 were of children aged 12 or older – up from 2% in 2004, when infants made up nearly half of all intercountry adoptions.2

This means the majority of children adopted internationally today have spent years in institutional care, foster care, or a combination of both. In addition to being older, children available for intercountry adoption often have special medical or developmental needs. While not all children whose adoptions are labeled as “special needs” have lifelong conditions, many need corrective treatment, surgeries, or therapies. The cost of additional services and medical care comes on top of the rising cost of intercountry adoption, which can cost families anywhere from $25,000 to $50,000 by the time they return home with their child.

Major Risks in Simultaneous Placements: Attachment and Resource Strain

Given the shrinking number of younger and healthier children available for adoption and the rising stakes for those children remaining in institutional care, many families are looking to adopt more than one child at a time. Proponents argue that adopting multiple children at once provides them with a sibling companion with the same language and culture of origin and minimizes travel, cost, and disruption to the adoptive family.

Whether adopting one child or two, adoptive parents’ primary focus must be on forming a healthy attachment between family members. Sarah MacLaughlin, LSW is a senior writer for Zero to Three, a global nonprofit focused on early childhood development education, and a former adoption and foster care director. She underscores the importance of healthy attachment: “Attachment theory tells us that it is a biological imperative for survival that drives infants to want to be close to their caregivers. This close sense of connection and security allows for optimal development and mental health.” Children who are denied this ideal connection at the right age can still be capable of forming healthy attachments to new caregivers, but it may require a great deal of effort.

When a child is adopted after infancy, attachments must be formed in several directions: attachment on the part of the child to each parent, attachment on the part of each parent to the child, and attachment between the child and existing siblings. Two children entering a family simultaneously create more than twice the attachment relationships to be formed – the children are each forming relationships between parents and existing siblings, but also with one another. For example, a family with two parents and one existing child who adopts one new child has three new relationships to manage, traveling in both directions for a total of six “attachments.” That same family, opting to adopt two new children at once, now has seven new relationships to manage, for a total of fourteen attachment connections. MacLaughlin points out that simultaneous adoptions may negatively impact a child’s attachment process: “Children are resilient, but when they are adopted after infancy, they should not have to compete with others who are in their same situation.”

Research has shown that children who spend formative years being raised in orphanage environments often experience “complex developmental trauma,” a diagnosis describing the experience of stress and interpersonal trauma over time. It can cause developmental delays and impaired coping skills, and even affect brain chemistry. These children can lack the ability to form healthy connections with others and exhibit many behaviors that make attachment a greater challenge for parents.3 When a family adopts two high-risk children at once, they stretch their own capacity for attachment and heighten the risk to all children in the family. Unresolved trauma on the part of an adopted child can also have a significant impact on other children in the home, and simultaneous adoptees may find their stress heightened by the developmental needs or trauma of their new sibling.

After adoptive parents return to the United States, they are also faced with the reality of meeting their children’s physical needs. Parents may often find out in the moment that their resources, skills, expectations, and support may be stretched further than anticipated. Children adopted internationally are often behind in medical care, dental care, emotional development, and academics. It is not unusual for a child adopted internationally to take a full year (or more) to catch up on care, nutrition, development, and form healthy attachments with parents.4 Not only can this first year be exhausting emotionally, the strain on a family’s time and financial resources may be significant. Money saved on travel and adoption expenses when a family adopts two children at once can be eaten up by the immediate doubling of medical and dental bills, therapeutic interventions, clothing and food costs, and parental time away from work. Families may also find that friends and relatives identified for childcare and respite may only be able to handle one child at a time, doubling the need for caregivers (or halving the amount of time parents have for self-care).

While most adoptions are considered a success by the families who adopt and the agencies that support them, a growing number of intercountry adoptions are ending in dissolution. Families that experience a disrupted adoption often cite a failure to attach, manifesting itself as a perceived “mismatch” between parent and child. These situations may be exacerbated by a lack of support within the family system or community, a shortage of resources both internally and externally to the family, unsafe behaviors on the part of the adoptee, and/or family stressors unrelated to the adoption.

Higher Rates of Adoption Disruption and Dissolution with Multiples

Specific numbers of adoptions that end in disruption or dissolution are hard to come by, but a range of research projects puts the number around 5-10%. In FY2010, the U.S. Department of State reported that 41 children who were adopted internationally entered into state care as a result of disruption (See for more information). Hard numbers are difficult to come by, as disrupted adoptions carry a stigma, and many families try to handle their dissolution privately without contacting or involving state systems.

Even less data is available on disrupted adoptions when more than one child is adopted at one time, but anecdotal evidence from National Council For Adoption (NCFA) members suggests the risk of disruption is much higher for these families. In a survey presented to member agencies in August 2016, one-third of respondents shared professional experience with adoptive families experiencing major challenges or disruption when adopting more than one child at a time. Kristi Gleason, the Senior Director of Global Programs at Bethany Global, reports: “[W]e have learned that these types of placements are less stable than singular placements, have more risk for disruption or dissolution, and that families and the children struggle more in the transition since coming home.”

Laura Beauvais, an Executive Director at Nightlight Christian Adoptions, knows firsthand the challenges families face when adopting internationally. Her own perspective has changed throughout her years in adoption. “I came from a place of supporting simultaneous adoptions in the past, citing the benefits of shared heritage, reduced costs, and getting more kids into homes and out of care,” she explains. However, in recent years, she began to see the difficult reality many families faced, as calls came in from overwhelmed parents. The need for new adoptive homes for adoptees in crisis became great enough that Beauvais developed the ReNewEd Hope program, an agency-supported avenue for adoptive parents to relinquish children to new adoptive homes. The program receives an average of one crisis call per week, and she expects to place ten children in the program before the end of the year. “It’s tragic what we’re seeing,” she says. “And it’s a disproportionate number of families adopting multiple older children with special needs at one time.”

Rhonda Jarema, Executive Director of Nightlight’s California program, says, “The children, even if they have a prior relationship, are each trying to find their place in the family. They are set up to compete for attention from family members. This makes the home environment more chaotic and less conducive to attachment.” Nightlight’s Vice President, Lisa Prather, points out a difficult truth shared by many of the NCFA member respondents: In the stressful work of forming parental attachments with more than one child, “one child often becomes the ‘perfect child’ and the other becomes the ‘bad child.’”

The thought that these disrupted children are just too traumatized to successfully integrate into a family does not bear out, either. Nightlight reports that children adopted through the ReNewEd Hope program with well-prepared families do well – even those that have struggled in their first adoptive homes for years. “Sometimes a family can only really focus on or attach to one child at a time,” Laura Beauvais says. This opinion is widely shared by other adoption professionals who work for NCFA member agencies, with most survey respondents raising concerns about attachment in their survey responses, often noting that each child deserves their special time to be the focus when joining a family.

The difficulties faced by “multiples” are also well documented outside of the practice of adoption. Parents who give birth to twins or multiples experience greater marital stress, higher incidences of postpartum depression, and more financial strain. Research shows that parents who give birth to multiples have a higher incidence of divorce than those who have singleton pregnancies.5,6 A sense of community and support within these families is high, with one national nonprofit, Multiples of America (, offering 475 local support groups throughout the country. While many more families with multiples thrive than not, and many families adopting simultaneously are successful, the implications and risks for these families cannot be overlooked. When we look at the research available on parents who have multiple children born to them at one time, and then in turn examine the adoption of multiple children via intercountry adoption who are likely to be older and have special needs, it is impossible to deny that these parents will face significant challenges.

Taking the Leap with Two: Best Practices and Red Flags

In the survey of NCFA members on the practice of simultaneous multiple adoptions, 20% of respondents said their agencies regularly allow simultaneous multiple placements. 80% of respondents said they either had strict policies against such placements (33%), or only approved such cases with “rare exception” (47%). This means, for better or for worse, many agencies are working with families on placements in which more than one unrelated child will enter the home together.

In these cases, how can agencies ensure they are approving families with the best shot at a positive outcome? Several agencies, including but not limited to Bethany Global, America World Adoptions, Nightlight Christian Adoptions, Lutheran Family and Children's Services of Missouri and Minnesota, and Children’s Hope International, shared their practices and views both for and against multiple placements via survey responses, emails, and phone calls. These are some of the experiences and best practices that have shaped knowledge on the practice of simultaneous placements:

Home Study Basics

It is inarguable that families seeking to adopt multiple children will have more challenges. In these cases, the strength of the home study is crucial. In Assessing Adoptive and Foster Parents: Improving Analysis and Understanding of Parenting Capacity, the authors describe ideal adoptive parents as showing resiliency, capacity for understanding and managing complex and challenging behaviors, openness to support and outside resources, self-awareness, and the ability to maintain self-care.7 Many families come to adoption with a wealth of knowledge, but many others are trusting in their agency and social workers to help make an accurate assessment of what they are able to handle.

In many cases, the home study provider is not the one who determines specific placement, and it is important to closely consider the assessment of the home study provider and agency who wrote a family’s study. Some home study agencies report pushback from other placement programs, which can create tension among colleagues who should be working in tandem to ensure safe placements for children. One social worker shared, “It’s problematic when someone at a placing program is urging me to change my approval on a family when I feel really strongly about their capacity as adoptive parents. It creates a lot of tension and puts us in the role of ‘bad cop,’ particularly when the placing agency colludes with the family to change the outcome.” When a difference of opinion between the home study agency and the placing agency exist, it’s best practice for that placing agency to support the home study agency’s assessment.

Experience and Timing

Families with the best chance of success with a challenging placement are families that have adopted in the past. Survey participants who offered insight into their practices largely agreed that experienced homes are necessary for simultaneous adoption. Parents with no prior parenting experience and no prior adoption experience are not good candidates for multiple placements. At the same time, those experienced adoptive families are best poised to rise to the challenge when a significant amount of time has passed since their last child was added to the family. We professionals should raise a red flag, however, when a family has adopted within the past year and are already looking to restart the process with one or more children. Attachment relationships are still forming in that first year, and it would be a significant challenge to add more children so quickly.


Families wishing to add more than one child at a time should bear out additional scrutiny as to their available resources. This means across the board – financial resources, hands-on time, and emotional bandwidth. Multiple member agencies reported experiencing higher disruption rates in multiple placement families with a single parent. The amount of energy required to incorporate two children into a family and manage their care is often much more than one adult can handle. Some agencies also look closely at the schedules of the two-parent families – is there room for a lot of flexibility? Can this family devote the time necessary for therapeutic parenting? Outside of parental availability, does the family have the resources to provide adequate care for the number of children in the home?

Intercountry adoptions involving older children and special needs often involve hefty medical and therapy bills. Is the family resourced to handle unexpected and additional diagnoses that may surface? Just as important are internal resources: Do parents have the ability to both maintain and relinquish control? Can they stay calm under intense pressure? Can they be both highly organized and flexible when necessary? Prospective adoptive parents of any child need to have identified self-care strategies, but those adopting multiple children at one time need to be particularly self-aware and have the ability to get their own needs met while helping others.

Adoption Education and Preparedness

Adoptive families that feel prepared to take on more than one child at once should also show a willingness to engage in extra education and advance planning. In addition to their extensive adoption preparedness requirements for all adoptive families, America World Adoptions requires families to complete an additional eight-page application to adopt multiple children. This application clearly states that applying does not guarantee acceptance, and asks families to examine their feelings on sensitive issues likely to emerge with multiple placements. It is best practice to have families complete additional training on therapeutic parenting and become well versed in interventions, such as The Connected Child and Trust-Based Relational Intervention (TBRI). Families should also identify local therapeutic providers, such as attachment therapists, and connect with them before they travel. It is not enough to provide families with a list of resources to be used “in case,” as those families will be in no position to find time to learn new strategies if they are mid-crisis.

Preparing families for success also means some hard gut checks on the worst-case scenarios. What are our blind spots as social workers and program providers? Several members shared situations in which they were able to identify weaknesses in hindsight. While this is all a part of our work and nearly impossible to avoid, it can shape our practice moving forward. Are workers asking the tough questions, and then really assessing the family’s reactions to those scenarios? Laura Beauvais from Nightlight shares some questions that could be used ahead of time to explore reactions to the most common issues she hears from families in crisis with the ReNewEd Hope program: “What would you do if one child is acting out sexually toward the other child? What behaviors would define this to you? What happens if you like one child more than the other? How do you handle situations that are out of your control?”

Consider Relationships

Many agencies responding to this informal survey make rare allowances for adopting multiple unrelated children, with the caveat that the children identified for adoption should be attached to one another already, and a determination should be made that their simultaneous adoption would benefit both. Some agencies make exceptions only for sibling groups. Children who are already securely attached to one another will have fewer relationships to build when adopted as a pair, though it is important to remember that the parents will still have the additional attachments to create, regardless of how stable the children’s existing relationship is. Placing attached children together can also mitigate the further trauma of separation. Still, providers should make extra efforts to prepare families with relevant training and continued support post-placement to ensure they are capable of handling the extra needs that come with multiple placements, even in sibling groups. Parents must be very carefully considered, even when the multiple placement is a sibling group.

At times, a close existing relationship between children can delay attachment or create a jealous dynamic in which one child attempts to undermine the attachment of their sibling to the adoptive parents. Parents approved for multiple placements need the emotional resiliency required to stick with the children as the attachments to the parents and other siblings in the home develop. In his memoir, Marcus Samuelsson, adopted from Ethiopia at age two with his older sister, tells the story of how his adoptive mother had to first win over his sister (the “lion”) before being allowed access to him, as she was ferocious in her protection of her brother.8 He reflects on his mother’s calm, enduring patience in this delicate task.

Assessing Motives

When a family seeks to adopt more than one child at a time, agencies should closely examine the motives of the family, and the type of placements that family is open to. There are a number of situations that should give pause in the true preparedness or motivation of a family. Prospective adoptive parents who have identified children without assistance from an agency may be selecting children who are ill suited for simultaneous adoption. For example, a toddler with Down Syndrome and a young teen who is in danger of “aging out” of the institution and are otherwise unknown to one another should not pass the straight-face test for a multiple placement, as they will have vastly different developmental and attachment needs.

What is at the root of this simultaneous adoption request? Often it comes down to financial reasons, available grant monies for specific scenarios, travel expenses, and timing. There may also be a well-meaning but misplaced sense of “saving” the orphans that are least likely to be adopted. The reality is that an ill-planned dual adoption may put a child at risk of a poor fit or disruption, while missing an opportunity to be placed in a home where he or she is the center of attention. When we assume that “no one else will want this child,” we are putting our fears and emotions for these children ahead of their best interest – and we are also taking the focus off of working to find more suitable adoptive homes and avenues to permanency for more children. A family that is truly able to take on multiple children at one placement should also be open to taking the right placement, which most often means an existing sibling or family group.

The Extraordinary Family

Agencies agree that not all families are suited to adopt multiple children in one trip. So it stands to reason that these families who do obtain approval should be rare, and they should stand out in their home study. When considering families for these rare multiple-child adoptions, agencies are looking for stable families with significant financial resources, support, and resiliency. Many families have a huge heart for children and for adoption, but a desire to help as many children as possible is not reason enough to approve simultaneous adoptions. As one NCFA member noted, “Potential adoptive parents need to make extraordinary efforts to demonstrate readiness.”

Ethics and Final Reflection

With so many children living in traumatic circumstances the world over, it’s a complicated and emotional task to weigh the ethics involved in intercountry adoption. Regardless of our individual stances on placement practices, it’s fair to say that those working in the adoption field want to see as many children placed in permanent homes as possible. We look within our own programs and see the amazing families we work with, and simultaneous placement makes sense on paper – it looks like a solution worth pursuing. It can be difficult to face a persistent family and say “no” when the risks are too high.

But it’s important to remember that we are not looking for better than placements for children. We are striving for best interest placements. In placing multiple children at once, or children out of birth order, or children too close in age, we may be inviting family disruption. That affects the parents in that system, the children already in the home, and the children entering the home. This may mean a particular family is not the best suited for a high-risk placement.

It is also critical to remember that adoption is the act of growing families and relationships, and that our capacities as human beings cannot always be reduced to hard and fast rules that can cover all situations. In a conversation with Laura Beauvais at Nightlight, she reminded me, “There is a place where our judgement meets objective criteria”—and in that place, we can find amazing families suited to taking on the most challenging adoption scenarios. Maintaining flexibility and a teachable spirit creates space for growth for all of us.

The plight of children around the world is only growing direr, as intercountry adoption becomes more difficult to navigate and adoption rates fall. While adoption is not the only solution to helping these children living outside family care, its biggest advantage is the offer of permanency. We offer these children and our profession the strongest service when our programs minimize risk for adoption disruption and offer children the enduring, loving homes they deserve.


  1. U.S. Department of State. (2016). Adoptions Abroad Statistics. Retrieved from
  2. Id.
  3. Purvis, K. B., Cross, D. R., Dansereau, D. F., & Parris, S. R. (2013). Trust-Based Relational Intervention (TBRI): A Systemic Approach to Complex Developmental Trauma. Child and Youth Services. Retrieved from
  4. EMK Press. (n.d.). The First Year Home. Expectations.pdf, pp. 1-52.
  5. McKay, S. (2010). The Effects of Twins and Multiple Births on Families and Their Living Standards. University of Birmingham. Retrieved from
  6. Anupam, J. B., Goldman, D. P., & Joyce, G. (2011, April). Association Between the Birth of Twins and Parental Divorce. Obstet Gynecol, 117(4), 892-897. Retrieved from
  7. Alper, J., & Howe, D. (2015). Assessing Adoptive and Foster Parents: Improving Analysis and Understanding of Parenting Capacity. London and Philadelphia: Jessica Kingsley Publishers.
  8. Samuelsson, M. (2013). Yes, Chef. New York: Random House Trade Press.

Additional References

Additional Reading and Resources