Simply put, mental illness doesn't show on the outside.  Autism cannot be predicted.  If it's a matter of physical health, many health issues resolve themselves, or appear to be developmental delays at various ages.  The agency needed to prepare them for how to parent an emotionally hurt, injured or frail child.  THey need to accurately report to the best of their ability.  No agency, international or U.S. based has figured out exactly how to do this without occassional mistakes.  The biggest mistake is placing a child with a high level of special needs with a parent who is unwilling or (more often) unable to help that child (due to lack of information, education or resources)

Each child is referred with paperwork, sometimes videos and photos.  Parents take these to medical experts in the field of International Adoption Medicine.  I know someone who took theirs to a plastic surgeon.  They were told that the kids in the photo were severely disabled and would never live independently.  I also know the person who eventually adopted those kids (guess who?) because she took the referral info to the proper doctor.  Agencies can only control so much.