Are adopted and fostered children receiving the right diagnoses and treatments? A study by King’s College London (KCL) found that adopted and fostered children are being over-diagnosed with attachment disorder, but under-diagnosed with conduct and learning disabilities, which may be preventing them from receiving beneficial interventions.
Using the infrastructure of Britain’s National Health Service (NHS), the researchers reviewed 100 consecutive referrals from families all over the United Kingdom. Children were referred for evaluation with the National Adoption and Fostering Service, which provides specialist service for people who have been fostered or adopted. The research team compared what individuals were initially referred for with the later clinical assessments. Then, they measured the totals against statistics of disorders among ‘looked after children’ (children in state care), which was the most similar dataset available for comparing evaluations of adopted and fostered children. Looked after children have higher rates of neurodevelopmental disorders and learning problems than children who live with their birth families.
They found that attachment disorders, which were mentioned in 31% of referrals, were greatly over-diagnosed. In fact, only one of the 100 children was identified as having an attachment disorder, but the child had not been referred for attachment problems. On the other hand, the researchers anticipated a high rate of conduct disorder, but it was only mentioned in four percent of the referrals; the prevalence of conduct disorder in the national data was 10 times higher. Finally, they found that in clinical assessments, conduct disorders were identified 13 times more frequently than attachment disorders.
Children may be missing out on essential, effective treatments by not being diagnosed appropriately.
“It seems that clinicians may be making the diagnosis [for attachment disorder] based more on assumptions due to the child’s history, rather than because of specific symptoms. In doing so, the danger is that they are blinded to some of the more straightforward diagnoses, like ADHD or conduct disorders, for which there are good, evidence-based treatments.” Dr. Matt Woolgar, lead study author and researcher at the National Academy of Parenting Research from KCL’s Institute of Psychiatry.
This research is published in the journal Child and Adolescent Mental Health.
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