adoptionCommon mental health disorders are being ‘grossly under-identified’ among adopted and fostered children, and consequently these children are missing out on appropriate treatments, according to a new study by King’s College London.

The study of more than 100 consecutive referrals from across the UK found that clinicians are over-identifying more complex ‘attachment disorders’ rather than common conditions such as attention deficit hyperactivity disorder (ADHD) or conduct disorder.

Lead author Dr Matt Woolgar, from the university's Institute of Psychiatry, said: “There is real confusion around the term ‘attachment disorder’. Clinicians appear to be using this diagnosis to try and capture the complex mental health problems that adopted or fostered children often have.

"It seems that clinicians may be making the diagnosis based more on the 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. As a result, children are missing out on the treatments they need."

Significantly higher rates of common disorders
Woolgar’s team reviewed the referral letters with each child’s clinical assessment within South London and Maudsley NHS Foundation Trust, and to the expected rate of mental health disorders from national data.

Best estimates of the prevalence of mental health disorders for adopted or fostered children are based on the mental health of ‘looked after children’ -children in the care of the state- who have significantly higher rates of common disorders such as conduct problems, ADHD, learning problems and neurodevelopmental disorders compared to children in birth families.

They found that attachment disorders were over-diagnosed among adopted and fostered children whereas conduct problems, ADHD, anxiety or autism were under-diagnosed.

Attachment problems were mentioned in 31% of the referrals. Upon clinical assessment, only one child was identified as having potential attachment symptoms but this was for a child in the 69% not initially identified with attachment problems.

Only 4% of referrals identified conduct disorder but rates of this were about 10 times higher in the national data. In the clinical assessment, common disorders were diagnosed 13 times more frequently than attachment disorders. Unlike more common mental health disorders, there are no evidence-based treatments for attachment problems.

The findings are published in the journal Child and Adolescent Mental Health.