Parenting the Sexually Abused Child Inside
As a prospective adoptive parent, you may have some valid concerns
about sexual abuse. You may wonder what the special needs are of
children who have been sexually abused and whether you will be able
to meet those needs. By acquiring more knowledge, you will feel
more confident in taking on the challenges and rewards of adopting
a child with special needs.
Many parents who have already adopted sexually abused children
feel that their greatest obstacle was lack of information about
sexual abuse in general; about their particular child's history;
and about helpful resources such as support groups, skilled therapists
and sensitive reading materials. This article will provide you with
some basic information about child sexual abuse as well as some
special considerations for parents who adopt these children.
What Is Child Sexual Abuse?
Child sexual abuse is any forced or tricked sexual contact by an
adult or older child with a child. Usually the adult or older child
is in a position of power or authority over the child. Physical
force is generally not used, since there is usually a trusting relationship
between the adult or older child and the child who is abused.
There are various types of sexual activity which may take place.
It can include open mouth kissing, touching, fondling, manipulation
of the genitals, anus or breasts with fingers, lips, tongue or with
an object. It may include intercourse. Children may not have been
touched themselves but may have been forced to perform sexual acts
on an adult or older child. Sometimes children are forced or tricked
into disrobing for photography or are made to have sexual contact
with other children while adults watch.
Child sexual abuse does not always involve physical touching. It
can include any experience or attitude imposed on a child that gets
in the way of the development of healthy sexual responses or behaviors.
For example, a child may be a victim of "emotional incest."
If a mother tells her son, in great detail, about her sexual exploits,
or if a father promises his daughter that she will be his life partner
when she turns 18, these would be scenarios in which the child could
be considered sexually abused. Siblings who are aware of a brother
or sister's victimization, but are not actually abused themselves,
may also suffer many of the same effects as an abused child.
In addition, some children experience ritualistic and/or satanic
abuse. Ken Wooden, founder of the National Coalition for Children's
Justice, defines ritualistic abuse as a bizarre, systematic continuing
abuse which is mentally, physically, and sexually abusive of children,
and for the purpose of implanting evil.
[Back to Top]
How Often Does Child Sexual Abuse Occur?
Estimates are that approximately 1 in 4 girls and 1 in 8 boys experience
sexual abuse in some way before they are 18. Data on how many of
these children live in foster or adoptive homes are not available.
Foster care and adoption social workers are now saying they believe
the percentages of boys and girls in foster care who have been sexually
abused are much higher than in the general population, perhaps as
high as 75%. Many came into foster care initially because of sexual
abuse and others are children who were re-victimized while in foster
care, either by an older foster child or by an adult.
[Back to Top]
What Behaviors or Signs Might You See in a
Child Who Has Been Sexually Abused?
While no one sign or behavior can be considered absolute proof
that sexual abuse has occurred, you should consider the possibility
of sexual abuse when one or several of these signs or behaviors
- Scratches, bruises, itching, rashes, cuts or injuries, especially
in the genital area
- Venereal disease
- Pregnancy in (young) adolescents
- Blood or discharge in bedding or clothes, especially underwear
- Aggressive behavior towards younger children
- Advanced sexual knowledge for the child's age
- Seductive or "sexy" behavior towards adults or peers
- Pseudo-mature behavior (for instance, a girl who is eight and
dresses like a 16 year-old, wears makeup and generally acts "too
old for her age," or a young boy who attempts to be his mother's
"man" in every sense of the word)
- Regressed behavior (for example, the child who has been toilet
trained starts wetting the bed)
- Excessive masturbation, masturbation in public places, difficulty
with being re-focused to another behavior
- Poor relationships with peers
- Fear of a particular person, place or thing (for example, if
the abuse occurred in the bathroom, the child may show fear in
- Sudden or extreme changes in behavior (for instance, a previously
good student starts having trouble with school work, a child who
was not sad before starts crying frequently or acting sad, or
a formerly cooperative child acts defiantly or is uncooperative
or unusually overly cooperative)
- Eating disorders (overeats, undereats)
Additional Behavioral Signs in Pre-teens and Adolescents
- Self-mutilation (the child may repeatedly pick at scabs, cut
him/herself with a razor blade, bite his/her finger or arm, burn
him/herself with a cigarette)
- Threatening or attempting suicide
- Using drugs or alcohol
- Becoming promiscuous (a child is sexually active without discrimination,
or just has that reputation)
- Being prudish (the child avoids any sexuality, does not see
him/herself as a sexual being in any way)
- Lying, stealing
- Running away
- Isolating self or dropping friends
- Pre-occupation with death (the child may write poems about death,
may ask a lot of questions about death, such as "What does
it feel like and where do people go?")
Some Additional Behavioral Signs in Children Who Have Been Ritualistically/Satanically
- Bizarre nightmares
- Sadistic play (for example, mutilation of dolls or small animals)
- Pre-occupation with death
- Increased agitation on certain dates which represent satanic
high holy days
- A constant fear of harm and extreme fear of being alone
[Back to Top]
Are All Children Affected Equally by Child
There is a myth that all children who have been sexually abused
are "damaged goods" and that the damage is for life. In
fact, with guidance and support a child who has experienced sexual
abuse can certainly recover and go on to live a happy, successful
life with loving and trusting relationships. However, there are
many factors which influence the extent of the child's trauma and
subsequent healing process. Some of these are:
The age of the child when the abuse began. Children abused
very early in life may carry body or sensory memories of the abuse
but will not have the words to express their rage. One adult survivor
of sexual abuse figured out, with the help of therapy, that the
reason she became sexually stimulated when she heard and felt a
room fan was because a fan had always been on when she was molested
as a child. Children who are abused pre-pubescently, during the
time when their sexuality is emerging, may carry greater effects
of the abuse.
The relationship of the primary perpetrator to the child.
A child's trust of his/her primary caretaker is central to their
relationship. Therefore, when abuse occurs in this context, the
betrayal is intensified.
How long the abuse occurred. The longer the abuse occurred,
the more likely the victim is to feel that he/she should have been
able to stop it and thus he or she feels more "guilty."
Whether there was violence involved. In most cases where
the abuse included violence or potential violence (that is, the
victim was made to understand that without cooperation there would
be violence) the child will have experienced additional trauma and
therefore damage to his/her development
The social system available to the child at the time of abuse.
The child who had someone to tell about the abuse will suffer less
than the child who had no one to tell. And even in some cases where
the support system is available, the child may choose not to tell
for fear of the consequences. For example, the child may think,
"If I tell my father that my brother is abusing me and he believes
me, then my father may do something drastic like hurt my brother
or send me to jail."
When children reveal their secrets, the response of adults will
vary. It is important to stay as calm as possible so as not to further
traumatize the child. The rage you may feel is natural, but the
child may perceive that it is directed at him or her. The child
needs a safe, supportive atmosphere in which to talk. Children also
benefit enormously from hearing that this has happened to other
children, male and female.
Ego development of the child at the time of the abuse. If
the child has a firmly established concept of his or her sexual
identity, the abuse will have less impact. Children who are abused
by a same sex perpetrator often have deeply felt fears about whether
this means they are homosexual. One way in which parents can help
allay this fear is to explain that our bodies have many nerve endings.
If these nerve endings are stimulated, they will react. For example,
if a bright light hits your eyes, your first response will be to
blink or to shade them from the light. A simple concept to use with
children is that of tickling. If a child is ticklish, he or she
will laugh when tickled. It does not matter whether the person tickling
is male or female; the child is reacting to the experience.
If the perpetrator is of the opposite sex, questions of identity
may also come into play. For example a boy who is abused by a woman
and is not aroused, may doubt his masculinity. If he is aroused
physically, but not emotionally, he may equally doubt his masculinity.
The same identity issues for girls may hold true.
If the child has a positive self-concept, that is, if he or she
feels valued at the time the abuse occurred, there will be fewer
repercussions. In fact, children with good self-esteem are more
likely to feel they can say no and/or tell someone about the abuse.
[Back to Top]
Do Boys Who Are Abused Have Special Issues?
Boys who are sexually abused face some additional problems because
of persistent myths in our society. Males are rarely viewed as fitting
the victim role. When boys get hurt, they are often told "act
like a man," "don't be a sissy," "control your
emotions." The message to boys is to stand on their own two
feet and to take care of themselves. Under these circumstances,
a male victim is less likely to tell and therefore cannot begin
a healing process. This increases the chances that he may take on
the role of the victimizer in an attempt to master his own experience.
A further complication for boys is that the media portray boys
who have sexual experiences with older women as going through a
"rite of passage" rather than as victims of sexual exploitation.
Movies such as "Summer of '42" and "Get Out Your
Handkerchiefs" are prime examples of this.
[Back to Top]
What About Juvenile Sex Offenders?
Some children who have been sexually abused go on to abuse other
children. While this is a serious problem, the exact percentage
of sexual abuse victims who become abusers is not known.
It is important to realize that these children are victims as well
as offenders and need to receive counseling from qualified therapists
who understand both aspects of the problem. The therapist must be
able to be empathic and understanding of the "victim"
but confrontational with the "victimizer."
Victimizers have triggers that precede their behavior. For example,
a child may abuse another child when he or she finds him or herself
in a vulnerable or stressful situation. Sometimes this is because
he or she lacks control or power. This may be when the child gets
called a name at school or believes he or she is being punished
unfairly. The therapist must help the child to not only recognize
his/her own individual triggers but also, to understand the consequences
of acting out these impulses.
In other instances, past experiences have left the child overly
sexually stimulated. The child needs education and suggestions of
alternative positive behaviors to replace the sexually victimizing
[Back to Top]
What Do Parents Need to Know When Adopting
a Child Who Has Experienced Sexual Abuse?
Parents who adopt children who have experienced sexual abuse need
the wisdom of Solomon, the strength of Hercules and the patience
of Mother Theresa. If you fall short in any of these areas, do not
despair. You are in good company. Perhaps, more important is your
desire to help a young person grow into a healthy, trusting adult.
This is a privilege and one which brings real satisfaction to those
who have adopted.
What Do Parents Need to be Aware of About Themselves?
It is very important for you as prospective adoptive parents to
be honest with yourselves and with your adoption worker about a
number of things:
Is there a history of sexual abuse in either the mother or father's
past? If there is, how were those experiences resolved? Did you
decide to "just forget about it" and chalk it up as one
of those things that just happened? Or did you get help, from your
parents, a teacher, a minister, a therapist or someone who could
help you work through your feelings about having been abused? Parents
with unresolved abuse experiences in their history may be at greater
risk for either abusing the child again, or for keeping too much
physical and emotional distance, for fear of abusing the child.
Parent/Survivors in local support groups regularly address these
How comfortable are you as prospective parents, with your own sexuality
and with your sexual relationship(s)? Can you talk comfortably about
sex? Do you give yourselves permission to acknowledge your own sexual
feelings, thoughts, fantasies and fears? Do you have a well-established
relationship which allows for direct and open communication? A child
who has been sexually abused may need to talk about what happened
to him or her. The child's behavior may be seductive or blatantly
sexual at times. A parent must be able to deal with this.
In addition, there are some other issues that are important for
adoptive parents to consider. They are:
A willingness to "be different," or experience embarrassing
situations, at least for a while. Children who have been sexually
abused may behave toward their adoptive parents in ways which are
different than non-abused children. For example, Lisa, age 8, began
shouting loudly, in public places like the supermarket, that her
father had abused her. In fact, it was her biological father and
not her adoptive father who had abused her, but the strangers in
the supermarket obviously did not make the distinction.
An ability to wait for the child's commitment while not putting
off making your own. An abused child is often untrusting and
tied to the past. A child may repeatedly test your commitment to
him or her. She or he may feel that if you really and truly saw
her or him as they are, with all the scars, that you would not really
want him or her.
Many parents have the hope that their love will immediately ease
the mistrust their child has of the world and all its adults. What
one adoptive parent learned was "love has a different meaning
for my daughter. To her, it's simply a deal: You do this for me
and I'll do that for you. What a shock to discover that love is
not enough." A true, trusting love based on more than just
bargaining can come to pass with a sexually abused child, but it
will take time, consistency and patience.
A sense of humor. As with most situations in life, a good
hearty laugh helps.
What Do Parents Need to be Aware of About Their Child Who Has
Been Sexually Abused?
Children who have experienced sexual abuse will probably need help
in learning new behaviors and ways of relating. Some of the behaviors
and emotions you may see expressed by your child are:
Withdrawal: Overwhelmed by the feelings she or he has experienced,
the child may retreat physically or emotionally. As a parent, you
may feel confused or resentful. It can be very isolating to have
someone close to you tune you out. Unless you think there is danger
of physical harm to the child or others, the best course of action
is to reassure the child that you care and that you will provide
the limits and boundaries that your child needs.
Mood Swings: A moment's tenderness can quickly explode into
anger. The child may be full of confidence one day, only to sink
into despair the next. It is difficult to see someone you care about
in pain, but you cannot control the feelings of someone else. Point
out that these mood swings are occurring. Do not allow yourself
to be unfairly blamed. Try to stay calm and accepting that sometimes
the child does not even know when or why his/her mood swings are
occurring. Crying jags can be part of these mood swings. Accept
that it is beyond your power to make it all better. Sometimes when
a parent tries to rescue a child from his or her pain, he or she
ends up feeling guilty, resentful and frustrated when it does not
work. When a caterpillar is emerging from the cocoon, it must have
a period of time to build strength in its wings. If the butterfly
is released from its cocoon before its time, its strength will be
diminished and it will not be able to survive on its own.
Anger: The first target for the child's angry feelings may
be the person he or she has come to feel the safest with -- you.
When a person's angry feelings are completely out of proportion
to what is going on, it probably has nothing to do with the present
situation. Something in the present is triggering and re-stimulating
old memories and feelings. The safety of the current situation allows
these feelings to be expressed. Recognize that this is actually
a sign of health, but do not accept unacceptable behavior; and never
expose yourself to physical violence.
You can assure your child that you are willing to work out the
problem at hand, but in a safe and supportive manner. For example,
a child may be offered a pillow to beat on in order to vent his
or her anger.
Unreasonable Demands: Some children learn the survival skills
of manipulation and control. They may feel entitled to make unreasonable
demands for time, money or material goods. It is important not to
play into or get trapped by these demands. You need to maintain
a healthy relationship with your child. This will help the child
reduce these demands.
Sexual Behaviors: Since the abuse was acted out sexually,
the child needs help in sorting out the meaning of abuse, sex, love,
caring and intimacy. Some children may try to demand sexual activity,
while others may lose interest in any form of closeness. Think of
all the needs that are met through sex: intimacy, touch, validation,
companionship, affection, love, release, nurturance. Children need
to be re-taught ways that these needs can be met that are not sexual.
A child who has been sexually abused may feel:
- I am worthless and bad
- No person could care for me without a sexual relationship
- I am "damaged goods" (no one will want me again)
- I must have been responsible for the sexual abuse because
- it sometimes felt good physically
- it went on so long
- I never said "no"
- I really wasn't forced into it
- I never told anyone
- I hate my body
- I am uncomfortable with being touched because it reminds me
of the abuse
- I think I was abused but sometimes I think I must have imagined
- I blame my (biological) mother or father for not protecting
me but I can't talk about it; I don't want to hurt him/her
A child who has been sexually abused will benefit from clear guidelines
that set the rules both in the home and outside. These kinds of
rules will help provide the structure, comfort and security which
all children need to grow into healthy adults. Experts in the field
of adoption and child sexual abuse believe these guidelines are
particularly important during the first year after placement, when
the child is working hard to establish new relationships with his/her
adoptive family and to build trust.
The following guidelines address topics with specific reference
to children who have been sexually abused.
Privacy: Everyone has a right to privacy. Children should
be taught to knock when a door is closed and adults need to role
model the same behavior.
Bedrooms and Bathrooms: These two locations are often prime
stimuli for children who have been sexually abused, since abuse
commonly occurs in these rooms.
By the time children enter first grade, caution should be used
about children of the opposite sex sharing bedrooms or bath times.
It is not advisable to bring a child who has been sexually abused
into your bed. Cuddling may be overstimulating and misinterpreted.
A safer place to cuddle may be the living room couch.
Touching: No one should touch another person without permission.
A person's private parts (the area covered by a bathing suit) should
not be touched except during a medical examination or, in the case
of young children, if they need help with bathing or toileting.
Clothing: It is a good idea for family members to be conscious
of what they wear outside of the bedroom. Seeing others in their
underclothes or pajamas may be overstimulating to a child who has
been sexually abused.
Saying "No": Children need to learn that it is
their right to assertively say "no" when someone touches
them in a way they do not like. Help them to practice this.
Sex Education: All children, including the child who has
been sexually abused, need basic information about how they develop
sexually. They also will benefit from an atmosphere in which it
is OK to talk about sex. Appropriate words for body parts, such
as penis, vagina, breasts and buttocks, will give the child the
words to describe what happened to him or her. Suggestive or obscene
language is sometimes a trigger for old feelings for a child who
was sexually abused, and should not be allowed.
No "Secrets": Make it clear that no secret games,
particularly with adults, are allowed. Tell children if an adult
suggests such a game, they should tell you immediately.
Being Alone With One Other Person: If your child is behaving
seductively, aggressively or in a sexually acting out manner, these
are high risk situations. During those times, it is advisable not
to put yourself in the vulnerable position of being accused of abuse.
In addition, other children may be in jeopardy of being abused.
Therefore, whenever possible during these high risk situations,
try not to be alone with your child or allow him/her to be alone
with only one other child.
Wrestling and Tickling: As common and normal as these childhood
behaviors are, they are often tinged with sexual overtones. They
can put the weaker child in an overpowered and uncomfortable or
humiliating position. Keep tickling and wrestling to a minimum.
Behaviors and Feelings: Help children differentiate between
feelings and behaviors. It is normal to have all kinds of feelings,
including sexual feelings. However, everyone does not always act
on all the feelings he or she has. Everyone has choices about which
feelings he or she acts on, and everyone (except very young children)
must take responsibility for his or her own behavior.
[Back to Top]
Will Our Child and Family Need Professional
It is very likely that at some time or other parents of a child
who was sexually abused will need professional help and support
for themselves and their child. The type of therapy that will be
the most helpful, that is, individual, couple or family therapy,
will depend on a family's particular situation. When a child is
being seen in individual therapy, it is important that the parents,
who have the primary responsibility for the child, be in close contact
with the therapist, or included in the therapy. Try to choose a
therapist who is knowledgeable about both sexual abuse and adoption
issues and with whom you feel comfortable. If parents are not familiar
with the therapy resources in their area, they may want to ask their
adoption agency or local mental health center for a referral. There
are also some resources listed at the end of this paper which may
be helpful with referrals to therapists who are knowledgeable about
Support groups for adoptive parents or sexually abused children
and support groups for victims/survivors are another helpful resource.
Adoptive parents who have had a chance to talk with others who understand
the experience of parenting a sexually abused child say that this
kind of sharing is very useful. Dr. Nicholas Groth, a leading psychologist
in the field of sexual abuse, along with many children and adult
victims/survivors, say that groups for children can be most effective
in the healing process. The opportunity to talk and share with other
children who have also experienced sexual abuse reduces a child's
sense of isolation and belief that he/she is the only one to whom
this has ever happened.
[Back to Top]
Is the Healing Ever Completed?
Recovery from child sexual abuse is an on-going process. As this
process unfolds, the child will ideally move from victim to survivor
to thriver. Developmental stages, particularly adolescence and young
adulthood, may trigger old feelings about the abuse. For example,
the time when an adolescent's body begins to develop physically,
or when he or she marries, or becomes a parent may restimulate old
feelings and memories.
As discussed earlier, so many factors can influence the extent
of the damage to the abused child. While adoptive parents cannot
erase what happened to their child earlier in his/her life, you
have a wonderful opportunity to provide your child with new, healthier
experiences. Those who have made the commitment to parenting a sexually
abused child say that the rewards of helping a child grow into a
healthy, vibrant adult are very satisfying indeed.
This paper was written for the National Adoption Information
Clearinghouse by Rosemary Narimanian of Philly Kids Play It Safe
and Julie Marks of the National Adoption Center in 1990.
Freeman, Lory. It's My Body. Parenting Press, Inc., Seattle,
Gil, Eliana. I Told My Secret: A Book for Kids Who Were Abused.
Launch Press, California, 1986.
Hindman, Jan. A Very Touching Book...for Little People and for
Big People. McClure-Hindman Associates, Durkee, OR, 1985.
Satullo, J. It Happens to Boys Too. RCC Berkshire Press,
Sweet, Phyllis. Something Happened to Me. Mother Courage
Press, Racine, WI, 1981.
Sweet, Phyllis. Alice Doesn't Babysit Anymore. McGovern
and Mulbacker, Oregon, 1985.
For Parents and Professionals
Bass, Ellen and Davis, Laura. The Courage to Heal, A Guide for
Women Survivors of Child Sexual Abuse. Harper & Row, New
Father Flanagan's Boys Home. Sexually Abused Children in Foster
Care. Boys Town, Nebraska. May be ordered by contacting Father
Flanagan's Boy's Home, Boys Town Center, Family Based Programs,
Boys Town, NE, 68010, (402) 498-1310.
Gil, Eliana. Outgrowing the Pain. Launch Press, California,
Gil, Eliana. Children Who Molest: A Guide for Parents of Young
Sex Offenders. Launch Press, California, 1987.
Lew, Mike. Victims No Longer: Men Recovering From Incest and
Other Sexual Child Abuse. Nevraumont Publishing Company, New
Maltz, Wendy and Holman, Beverly. Incest and Sexuality.
Lexington Books, Lexington, MA, 1986.
McFadden, Emily Jean. Fostering the Child Who Has Been Sexually
Abused. Eastern Michigan University, Ypsilanti, MI, 1986.
McFarlane, Kee and Cunningham, Carolyn. Steps to Healthy Touching:
A Treatment Workbook for Kids 5-12 Who Have Problems With Sexually
Inappropriate Behavior. Kidsrights, Mount Dora, FL, 1988.
Parents Anonymous of Delaware. All In My Family. Parents
Anonymous, DE, 1987.
Burgess, Ann; Hartman, Carol; McCormick, Arlene; and Janus, Mark
David. Adolescent Runaways, Causes and Consequences. Lexington
Books, Lexington, MA, 1987.
Finkelhur, David. Child Sexual Abuse, New Theory & Research.
The Free Press, New York, 1984.
James, Beverly. Treating Traumatized Children. Lexington
Books, Lexington, MA, 1989.
James, Beverly and Nasjleti, Maria. Treating Sexually Abused
Children and Their Families. Consulting Psychologists Press,
Inc., Palo Alto, CA, 1983.
MacFarlane, Kee and Waterman, Jill. Sexual Abuse of Young Children.
The Guildford Press, New York, 1986.
Sgroi, Suzanne. Handbook of Clinical Intervention in Child Sexual
Abuse. Lexington Books, Lexington, MA, 1988.
The National Resource Center on Child Sexual Abuse provides
information, resources and technical assistance to organizations
and professionals on child sexual abuse. It publishes the "Round
Table" Magazine and offers training for professionals. It also
maintains lists of treatment programs for victims in various parts
of the country. Write to the Center at 106 Lincoln Street, Huntsville,
AL 35801, or call (205) 533-KIDS (533-5437).
The National Clearinghouse on Child Abuse and Neglect collects
and disseminates information on child sexual abuse. It will do research
upon request on a particular subject at a very low cost. It also
has general publications which you can request. Write to the Clearinghouse
at 330 C Street, SW, Washington, DC 20447 or call at 1-800-394-3366.
(This link will open a new window to an external Web site. To
return to NAIC's Web site, close the new window.)
The National Adoption Information Clearinghouse maintains
a list of adoption experts who have expertise in many areas of adoption,
including the adoption of children who have experienced sexual abuse.
Contact the Clearinghouse for referrals to these experts by writing
the Clearinghouse at 330 C Street, SW, Washington, D.C. 20447 or
by calling 703-352-3488 or 1-888-251-0075.
The C. Henry Kempe National Center for the Prevention and Treatment
of Child Abuse and Neglect provides training, consultation,
research and program development on all forms of abuse and neglect.
Write to the Center at 1205 Oneida Street, Denver, CO 80220, or
call at 303-321-3963.
The National Adolescent Perpetrator Network is housed at
the C. Henry Kempe Center (see above). It can provide professionals
and parents with a bibliography on juvenile sex offenders and with
referrals to treatment programs for adolescent offenders. It also
operates a Perpetration Prevention Project which provides training
to professionals and paraprofessionals on "Understanding the
Sexual Behavior of Children." Write to the Network at 1205
Oneida Street, Denver, CO 80220, or call at 303-321-3963.
The National Runaway Switchboard is a 24 hour crisis line
for runaway youth and children considering running away. The Switchboard
offers limited problem solving in a confidential, non-judgmental
manner. It also offers a message service and a referral service
for youth in need of shelter. Call 1-800-621-4000.
[Back to Top]
Information provided by National Adoption Information