The author states that, over a five-year period in his private practice of child psychiatry, he found a much higher percentage of his patients to be adopted children than is true in the population at large. He presents case material, some of it analytic, to show how the fact of adoption plays a role. In being woven into the framework of each child's personality, it affects symptom formation and object relations. The fact of adoption has much more of an impact than fantasies of the family romance, especially in terms of fear of future abandonment; in one case, it served as the kernel of truth in a delusional system. The question is raised about the advisability of informing the child at an early date of his adopted status.