“The Cost of Diagnostic Oversight: Rumination Misattributed to Attachment in a Child With Tourette Syndrome. How an Adopted Child Stopped Feeling Embarrassed and His Parents Blamed after a Specialist Assessment that Led to Psychoeducation and Evidence-Based Interventions”

Abstract

This paper explores how an adoptive family’s feelings of blame and embarrassment shifted after receiving an accurate diagnosis for their 9-year-old child. Narratives of attachment and trauma had been used previously to explain the child’s rumination and regurgitation symptoms and excessive appetite from an early age. The paper outlines the assessment that ruled the previous explanation out and gave a diagnosis of Tourette syndrome, a neurodevelopmental disorder with an evidence-based pathway of care. It also examines the theory behind this revised formulation, integrating both environmental influences, biological predispositions and their interaction. The discussion explores the negative implications of neglecting biological factors in the mental health assessments of adopted children and interpreting their presentations through the lens of past trauma and attachment disruptions only, as lack of early identification and therefore, intervention can lead to serious long-term consequences. Conducting complex assessments require multidisciplinary specialist services with professionals trained in making differential diagnoses in adopted children, that include the consideration of neurodevelopmental and mental health problems. Such services should also offer consultation and provide training to other professionals working within the children’s complex systems.

Plain Language Summary

This paper describes a family who struggled with feelings of blame and embarrassment because of their adopted 9-year-old child’s unusual symptoms; specifically, repeated rumination and regurgitation. For years, these symptoms were thought to be caused by early trauma and attachment issues, which is a common explanation for children who have been in care. However, after a thorough mental health assessment, doctors discovered that the child actually had Tourette syndrome, a neurological brain-based condition that can explain these behaviours. This diagnosis helped the family answer their question of why this was happening, understand the problem was not lack of bonding between them, and gave them a clear plan for treatment, based on research. The paper also talks about how important it is to consider both biological and environmental factors when assessing mental health issues in children, especially those who are adopted or have been in care. Too often, professionals assume trauma is the cause of all problems, even when there is no clear evidence. This “one-size-fits-all” thinking can lead to misdiagnosis and unnecessary suffering. Finally, the paper argues that adopted children should be able to access expert services run by professionals trained to understand their full range of needs. These services are run by experts of different disciplines who should undertake the most complex of the assessments and also advice and provide training to other professionals working with adopted and care-experienced children.