There are tens of thousands of children in the United States who have special needs and are waiting for permanent homes. In the past, children who have special needs have been generally considered harder to place for adoption than others, but in reality, many children with special needs can be successfully placed. The Adoption and Safe Families Act of 1997 has focused more attention on finding permanent homes for those children who have special needs as well as making certain that they have the post adoption services they need.

When used in adoption, "special needs" may include several factors, and sometimes vary from one state to another. In general, children with special needs have physical or health problems, are older, are members of a minority group, have siblings and need to be adopted as a group, have HIV, have emotional problems, a history of abuse or neglect, have conditions that may lead to problems in the future, or have had some form of prenatal exposure to drugs or alcohol. Nearly all special needs children who are eligible for adoption are currently in foster care.

Nearly any adoptive parent who has the commitment, skills, and preparation to adopt may adopt a special needs child. Most agencies differ in their specific requirements for adopting a special needs child, and the requirements for age and marital status tend to be less restrictive for special needs children. Most agencies will consider both single and married applicants from 18 to 50 years of age, and sometimes even older than 50. The age is often considered differently depending on the age of the child. Most agencies require that married couples be married for at least 1 to 3 years.