In the United States, special needs is a term used in clinical diagnostic and functional development to describe individuals who require assistance for disabilities that may be medical, mental, or psychological. For instance, the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases 9th edition both give guidelines for clinical diagnosis. Types of special needs vary in severity. People with autism, Down syndrome, dyslexia, blindness, ADHD, or cystic fibrosis, for example, may be considered to have special needs. However, special needs can also include cleft lips and/or palates, port-wine stains, or missing limbs.
In the United Kingdom, special needs often refers to special needs within an educational context. This is also referred to as special educational needs (SEN). In the United States, 18.5 percent of all children under the age of 18 (over 13.5 million children) had special health care needs as of 2005.
More narrowly, it is a legal term applying in foster care in the United States, derived from the language in the Adoption and Safe Families Act of 1997. It is a diagnosis used to classify children as needing "more" services than those children without special needs who are in the foster care system. It is a diagnosis based on behavior, childhood and family history, and is usually made by a health care professional.
In the United States, more than 150,000 children with special needs are waiting for permanent homes. Traditionally, children with special needs have been considered harder to place for adoption than other children, but experience has shown that many children with special needs can be placed successfully with families who want them. The Adoption and Safe Families Act of 1997 (P.L. 105-89) has focused more attention on finding homes for children with special needs and making sure they receive the post-adoption services they need. Pre-adoption services are also of critical importance to ensure that adoptive parents are well prepared and equipped with the necessary resources for a successful adoption. The United States Congress enacted the law to ensure that children in foster care who cannot be reunited with their birth parents are freed for adoption and placed with permanent families as quickly as possible.