The first social history of disability and difference in American adoption, from the Progressive Era to the end of the twentieth century. Disability and child welfare, together and apart, are major concerns in American society. Today, about 125,000 children in foster care are eligible and waiting for adoption, and while many children wait more than two years to be adopted, children with disabilities wait even longer. In Familial Fitness, Sandra M. Sufian uncovers how disability operates as a fundamental category in the making of the American family, tracing major shifts in policy, practice, and attitudes about the adoptability of disabled children over the course of the twentieth century. Chronicling the long, complex history of disability, Familial Fitness explores how notions and practices of adoption have—and haven’t—accommodated disability, and how the language of risk enters into that complicated relationship. We see how the field of adoption moved from widely excluding children with disabilities in the early twentieth century to partially including them at its close. As Sufian traces this historical process, she examines the forces that shaped, and continue to shape, access to the social institution of family and invites readers to rethink the meaning of family itself.