Adoption is accompanied by well-known risk factors that contribute to unique clinical challenges for children, parents, and clinicians. Adoption also serves to illustrate issues that remain relatively "silent" in the typical transition to parenthood. In this article, the authors review the normal developmental challenges that parents face during adoption, the adoption-related risk factors that may impinge on the child's development and attachment process, and the impact of adoption on the child's development of identity and filiations. We will review and illustrate clinical conditions often associated with adoption. In many countries, adoptive parents are reluctant to consult mental health clinicians during the first year of the adoption. The cases presented here illustrates the need to implement routine clinical programs for early detection and intervention of adoptive parent-infant dyads and triads at risk.