As children grow up, they develop a positive sense of their identity, a sense of psychosocial well-being. They gradually develop a self-concept (how they see themselves) and self-esteem (how much they like what they see). Ultimately, they learn to be comfortable with themselves. Adoption may make normal childhood issues of attachment, loss and self-image even more complex. Adopted children must come to terms with and integrate both their birth and adoptive families. Children who were adopted as infants are affected by the adoption throughout their lives. Children adopted later in life come to understand adoption during a different developmental stage. Those who have experienced trauma or neglect may remember such experiences, which further complicates their self-image. Transracial, crosscultural and special needs issues may also affect a child’s adoption experience. All adopted children grieve the loss of their biological family, their heritage and their culture to some extent. Adoptive parents can facilitate and assist this natural grieving process by being comfortable with using adoption language (eg, birth parents and birth family) and discussing adoption issues.