Parenting a child with a disability can be a source of stress and strain on marital and family relationships. Early research focused on the pathology or maladjustment in families raising a child with a disability. More recent research identified positive adjustment in families and uncovers potential difference factors when comparing adoptive and birth families raising children with special needs. Identifying specific parent and family characteristics that contribute to the adjustment to parenting a child with a disability and distinguishing between parents and families who purposely chose to adopt a child with special needs and parents and families who rear a birth child with special needs are critical for educating professionals working with expectant parents, adoptive parents, and families. Identification of these characteristics can inform professionals regarding services or interventions that may help families experiencing difficulty adjusting to a child with special needs and can also support families during the prebirth and preadoptive placement decision-making process as well as throughout the child's life. This article reviews the existing literature on parenting a child with special needs, focusing on the characteristics, implications, and considerations of individuals who choose to adopt a child with a genetic or other physical or mental disability. The literature review includes information regarding which elements make the placements of children with disabilities successful, including adoptive parent expectations, experience with disabilities, preparedness and education needs, resources, and support systems. Finally, characteristics and challenges of expectant parents with high-risk or crisis pregnancies in which a fetal anomaly has been diagnosed are discussed with respect to appropriate training for health professionals who counsel patients seeking to determine an appropriate course of action during their decision-making process.