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Abstract Despite the increasing use of adoption to provide permanence for children living in out-of-home care, relatively little is known about the children involved. This paper presents findings on the previous life experiences of an entire cohort of 'difficult to place' adoptees who were placed in Australia over 26 years. Understanding the vulnerability of these children is important for practitioners supporting adoptive families, as well as policy-makers and researchers who are assessing the outcomes of adoption from care. The study describes a group of children who have experiences which may make them vulnerable to poor adult outcomes. The severity of their pre-care experiences is high, with implications for health and wellbeing difficulties in adulthood. Child welfare interventions after entry to out-of-home care are also associated with poor outcomes. Furthermore, a high number of adoptees presented with behavioural difficulties which further compromised their welfare. The study demonstrates that, while adoptive families can be successfully recruited for highly vulnerable children, there are important issues for timing of decision-making about permanency and for recruitment, training and support of adoptive families. Furthermore, policy makers and practitioners need to consider these vulnerabilities when comparing adoption with other forms of out-of-home care and assessing outcomes of adoption compared to the general community or fostered children. Highlights • A full cohort study of 'hard to place' adoptees from care over 26 years. • Adoptees are shown to have higher rates of 'significant' ACEs than the general population. • This vulnerability has been increased following child welfare interventions. • Significant implications for practice and assessing outcomes of adoption. [ABSTRACT FROM AUTHOR]