Abstract
The climate of international adoption has changed over the years. The actual number of children arriving in the United States and other countries as a result of international adoption has decreased but the medical complexity has increased. The number of “open” countries sending adopted children has dwindled. However, children from marginalized settings continue to find their way into homes in the United States via adoption. These children bring unique prenatal and postnatal histories into their adoptive homes. Understanding of the impact of preadoption history upon physical, mental, emotional, cognitive, and developmental well‐being is imperative for adoptive parents and for medical and mental health professionals, and schools.