Post-adoption service use and unmet service needs were examined longitudinally in three matched groups of children: children adopted from Romanian orphanages following a minimum of eight months' institutional experience (RO: n = 36); children from Romania who were destined for orphanages but were adopted early in infancy (EA: n = 25); and Canadian born non-adopted children (CB: n = 42). Data were collected when the adoptees had been in their adoptive homes for 11 months, at age 4.5 years and 10.5 years. Results indicated higher rates of service use and unmet service needs across time in the RO group. Unmet service needs in the RO group may be due in part to the unique challenges faced by post-institutionalized adoptees. Service use in the EA group jumped significantly at Phase 3, suggesting that the impact of their lesser degree of early deprivation was seen later in development under the additional challenge and stress of the demands of school. Findings, particularly from the EA group, supported the suggestion that adoptive parents have a lower threshold for referring their children for clinical services than do non-adoptive parents. Service needs of adoptees changed over time and those with unmet needs experienced greater challenges than those whose service needs were met. (Contains 8 tables.)