This article presents the characteristics of 83 looked after and 67 adopted children at the time of their first assessment by a designated mental health team in the context of potential appropriateness of this service. Attachment and mental health problems were significantly associated across most subscales of the Relationships Problems (RPQ) and the Strengths and Difficulties Questionnaires (SDQ). Adopted children were younger and were rated higher on both measures. One-third of the children were rated below the clinical cut-off SDQ score. The service appeared to adopt broad referral criteria to include attachment difficulties rather than just mental health disorders. The findings are discussed in relation to the varied interpretation of the constructs of attachment difficulties and disorders, and the future development of care pathways for looked after and adopted children.
AllenJVostanisP (2005) The impact of abuse and trauma on the developing child: an evaluation of a training programme for foster carers and supervising social workers. Adoption & Fostering29(3): 68–81.
2.
BellamyJLGopalanGTraubeDE (2010) A national study of the impact of outpatient mental health services for children in long-term foster care. Clinical Child Psychology and Psychiatry15(4): 467–479.
3.
BlowerAAddoAHodgsonJLamingtonLTowlsonK (2004) Mental health of ‘looked after’ children: a needs assessment. Clinical Child Psychology and Psychiatry9(1): 117–129.
4.
BorisNWZeanahCHLarrieuJScheeringaMSHellerSS (1998) Attachment disorders in infancy and early childhood: a preliminary investigation of diagnostic criteria. American Journal of Psychiatry155(2): 295–297.
5.
BramlettMDRadelLFBlumbergSJ (2007) The health and well-being of adopted children. Pediatrics119(1): 54–60.
6.
CallaghanJYoungBPaceFVostanisP (2004) Evaluation of a new mental health service for looked after children. Clinical Child Psychology and Psychiatry9(1): 130–148.
7.
ChaffinMHansonRSaundersBNicholsTBarnettDZeanahCHBerlinerLEgelandBNewmanELyonTLeTourneauEMiller-PerrinC (2006) Report of the APSAC task force on attachment theory, reactive attachment disorder, and attachment problems. Child Maltreatment11(1): 76–89.
8.
ClarkAFO'MalleyAWoodhamABarrettBByfordS (2005) Children with complex mental health problems: needs, costs and predictors over one year. Child and Adolescent Mental Health10(4): 170–178.
9.
DorseySFarmerEBarthRGreeneKReidJLandsverkJ (2008) Current status and evidence base of training for foster and treatment foster parents. Children and Youth Services Review30(12): 1403–1416.
10.
FergusonLFollanMMacinnesMFurnivallJMinnisH (2011) Residential childcare workers' knowledge of reactive attachment disorder. Child and Adolescent Mental Health16(2): 101–109.
11.
FisherPKimH (2007) Intervention effects on foster preschoolers' attachment-related behaviors from a randomized trial. Prevention Science8: 161–170.
12.
FollanMAndersonSHuline-DickensSLidstoneEYoungDBrownGMinnisH (2011) Discrimination between attention deficit hyperactivity disorder and reactive attachment disorder in school aged children. Research in Developmental Disabilities32(2): 520–526.
13.
FordTVostanisPMeltzerHGoodmanR (2007) Psychiatric disorder among British children looked after by local authorities: a comparison with children living in private households. British Journal of Psychiatry190: 319–325.
14.
GoldingK (2003) Helping foster carers helping children: using attachment theory to guide practice. Adoption & Fostering27(2): 64–73.
15.
GoldingK (2007) Developing group-based parent training for foster and adoptive parents. Adoption & Fostering31(3): 39–48.
16.
GoldingK (2010) Multi-agency and specialist working to meet the mental health needs of children in care and adopted. Clinical Child Psychology and Psychiatry15(4): 573–587.
17.
GoodmanAGoodmanR (2011) Population mean scores predict child mental disorder rates: validating SDQ prevalence estimators in Britain. Journal of Child Psychology and Psychiatry52(1): 100–108.
18.
GoodmanAGoodmanR (2012) Strengths and Difficulties Questionnaire scores and mental health in looked after children. British Journal of Psychiatry200(5): 426–427.
19.
GoodmanR (2001) Psychometric properties of the Strengths and Difficulties Questionnaire. Journal of American Academy of Child and Adolescent Psychiatry40(11): 1337–1345.
20.
HolmesBSilverM (2010) Managing behaviour with attachment in mind. Adoption & Fostering34(1): 65–76.
21.
HoweD (2006) Developmental attachment psychotherapy with fostered and adopted children. Child and Adolescent Mental Health11(3): 128–134.
22.
HoweDFearnleyS (2003) Disorders of attachment in adopted and fostered children: recognition and treatment. Clinical Child Psychology and Psychiatry8(3): 369–387.
23.
HughesD (2004) An attachment-based treatment of maltreated children and young people. Attachment and Human Development6(3): 263–278.
24.
HughesD (2011) Attachment focused Family Therapy: Workbook, London: Norton.
25.
JufferFBakermans-KranenbergMvan IJzendoornM (2005) The importance of parenting in the development of disorganised attachment: evidence from a preventive intervention study in adoptive families. Journal of Child Psychology and Psychiatry46: 263–274.
26.
KarnikNVostanisPHuemerJKjelsbergEKaltiala-HeinoRSteinerH (2013) Epidemiology of psychiatric and substance use disorders among young offenders: current research, implications, and future directions. In: ThomasCRPopeK (eds) The Origins of Antisocial Behaviour: A developmental perspective, New York: Oxford University Press.
27.
KeyesMASharmaAElkinsIJIaconoWGMcGueM (2008) The mental health of US adolescents adopted in infancy. Pediatrics & Adolescent Medicine162(5): 419–425.
28.
LeveLDHaroldGTChamberlainPLandsverkJAFisherPAVostanisP (2012) Children in foster care: vulnerabilities and evidence-based interventions that promote resilience processes. Journal of Child Psychology and Psychiatry53(12): 1197–1211.
29.
McAuleyCDavisT (2009) Emotional well-being and mental health of looked after children in England. Child & Family Social Work14(2): 147–155.
30.
MeltzerHGatwardRCorbinTFordT (2003) The Mental Health of Young People Looked After by Local Authorities in England, London: TSO.
31.
MilburnNLynchMJacksonJ (2008) Early identification of mental health needs for children in care: a therapeutic assessment programme for statutory clients of child protection. Clinical Child Psychology and Psychiatry13(1): 31–47.
32.
MillwardRKennedyETowlsonKMinnisH (2006) Reactive attachment disorder in looked-after children. Emotional and Behavioural Difficulties11(4): 273–279.
33.
MinnisHRabe-HeskethSWolkindS (2002) Development of a brief, clinically relevant scale for measuring attachment disorders. International Journal of Methods in Psychiatric Research11(2): 90–98.
34.
MinnisHGreenJO'ConnorTGLiewAGlaserDTaylorEFollanMYoungDBarnesJGillbergCPelosiAArthurJBurstonAConnollyBSadiqFA (2009) An exploratory study of the association between reactive attachment disorder and attachment narratives in early school-age children. Journal of Child Psychology and Psychiatry50(8): 931–942.
35.
MinnisHReekieJYoungDO'ConnorTRonaldAGrayAPlominR (2007) Genetic, environmental and gender influences on attachment disorders behaviours. British Journal of Psychiatry190: 490–495.
36.
NICE (National Institute of Health and Clinical Excellence) (2010) Promoting the Quality of Life of Looked After Children and Young People, London: NICE.
37.
O'ConnorTGZeanahCH (2003) Attachment disorders: assessment strategies and treatment approaches. Attachment & Human Development5(3): 321–326.
38.
PuckeringCConnollyBWernerCToms-WhittleLThompsonLLennoxJMinnisH (2011) Rebuilding relationships: a pilot study of the effectiveness of the mellow parenting programme for children with reactive attachment disorder. Clinical Child Psychology and Psychiatry16(1): 73–87.
39.
RaoPAliAVostanisP (2010) Looked after and adopted children: How should specialist CAMHS be involved?Adoption & Fostering34(2): 58–72.
40.
RushtonAMonckELeeseMMcCronePSharacJ (2010) Enhancing adoptive parenting: a randomized controlled trial. Clinical Child Psychology and Psychiatry15(4): 529–542.
41.
RutterMKreppnerJSonuga-BarkeE (2009) Attachment insecurity, disinhibited attachment, and attachment disorders: Where do research findings leave the concepts?Journal of Child Psychology and Psychiatry50(5): 529–543.
42.
SchofieldGBeekM (2009) Growing up in foster care: providing a secure base through adolescence. Child & Family Social Work14(3): 255–266.
43.
SchoreAN (2001) Effects of a secure attachment relationship on right brain development, affect regulation, and infant mental health. Infant Mental Health Journal22(1-2): 7–66.
44.
SelwynJDel TufoSFrazerL (2009) It's a piece of cake? An evaluation of an adopter training programme. Adoption & Fostering33(1): 30–43.
45.
SprangG (2009) The efficacy of a relational treatment for maltreated children and their families. Child and Adolescent Mental Health14(2): 81–88.
46.
SteeleMHodgesJKaniukJHillmanSHendersonK (2003) Attachment representations and adoption: associations between maternal states of mind and emotion narratives in previously maltreated children. Journal of Child Psychotherapy29(2): 187–205.
47.
Stovall-McCloughKCDozierM (2004) Forming attachments in foster care: infant attachment behaviours during the first two months of placement. Development and Psychopathology16(253): 271.
48.
StreetEDaviesM (2002) Constructing mental health services for looked after children. Adoption & Fostering26(4): 65–75.
49.
TannerKTurneyD (2003) What do we know about child neglect? A critical review of the literature and its application to social work practice. Child & Family Social Work8(1): 25–34.
50.
Tarren-SweeneyM (2010) Concordance of mental health impairment and service utilization among children in care. Clinical Child Psychology and Psychiatry15(4): 481–495.
51.
VostanisP (2010) Mental health services for children in public care and other vulnerable groups: implications for international collaboration. Clinical Child Psychology and Psychiatry15(4): 555–571.
52.
VostanisPBassiGMeltzerHFordTGoodmanR (2008) Service use by looked after children with behavioural problems: findings from the England survey. Adoption & Fostering32(3): 23–32.
53.
World Health Organisation (WHO) (1993) The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic criteria for research, Geneva: World Health Organisation.
54.
ZeanahCHBerlinLJBorisNW (2011) Clinical applications of attachment theory and research for infants and young children. Journal of Child Psychology and Psychiatry52(8): 819–833.
