The need for improved recognition of neurodevelopmental conditions in adopted and fostered young people

Abstract

Care-experienced young people face higher rates of mental health issues and neurodevelopmental conditions compared to the general population. However, many of these young people and their families struggle to access effective support, with widespread dissatisfaction toward child and adolescent mental health services (CAMHS). This challenge is likely worsened by a growing tendency to overdiagnose attachment disorders and trauma, often at the expense of identifying more common conditions like autism and attention-deficit/hyperactivity disorder (ADHD). In this article, we highlight how adopted and fostered children are at a significantly higher risk for both autism and ADHD, due to a combination of genetic and environmental factors. We then explore how the failure to recognise these neurodevelopmental conditions can lead to poor outcomes for these young people and their families. Additionally, we emphasise the need to develop and support specialist services capable of conducting multidisciplinary assessments for this population, due to complex presentations that require careful differential diagnoses. Finally, we provide a case example of a 16-year-old girl referred to the National Adoption and Fostering Team (a Tier 4 National and Specialist CAMHS), which demonstrates how the previous failure to identify her autism and ADHD led to substantial harm.

Plain language summary

Young people who have been in foster care or adopted tend to have higher rates of mental health issues and developmental conditions, like autism and attention-deficit/hyperactivity disorder (ADHD), compared to others. Unfortunately, they and their families often find it difficult to access the right diagnoses for these problems, and there is widespread dissatisfaction with mental health services for children and young people who are care experienced. One reason for this is that some professionals focus too much on diagnosing issues like attachment disorders and trauma, while overlooking common conditions like autism and ADHD. This article explains that adopted and fostered children are at higher risk of developing autism and ADHD because of both their genetics and life experiences. When these conditions are not recognised, it can lead to worse outcomes for these young people and their families. The article stresses the need for specialised services that can assess these young people carefully, as their mental health problems and life experiences can be complex. Finally, we discuss a case example of a 16-year-old girl who was referred to the National Adoption and Fostering Team, which demonstrates how not identifying her autism and ADHD had caused her significant harm.