I think parental stress is the biggest one. Any parent who has a heavy role in caretaking when you have a child.... I've interviewed adoptive parents who say “We have five adopted children with special needs. It's a rare week when we don't get calls from the schools telling us to come and get one of our children.”
There is ongoing stress. There is not knowing if you're doing the right thing. There is a feeling of hopelessness that you can't give your children what they need. It's a matter of emotional overload for some of these parents. That component has to be factored in.