Common disorders, such as ADHD or conduct disorder, are being ‘grossly under-identified’ amongst adopted and fostered children, according to a new study by King’s College London. Instead, clinicians are over-identifying more complex ‘attachment disorders’, and as a result children are missing out on appropriate treatments.

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

It was reported last week that adopted children are being misdiagnosed with a more complex diagnosis than what they actually have.  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 conduct disorder were approximately 10 times higher in the national data. In the clinical assessment, common disorders were diagnosed much more frequently than attachment disorders, with conduct disorders diagnosed 13 times more frequently than attachment disorders.

Dr Matt Woolgar, lead author of the paper from the National Academy of Parenting Research at King’s College London’s Institute of Psychiatry, and consultant clinical psychologist at the National Adoption and Fostering Service at SLaM, says:

“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.”

Samantha Sanders, a child care and adoption solicitor at Ridley & Hall commented:

“Whilst it is great to hear that adopted children are getting the relevant medical help when a problem is identified, it is concerning to read that a lot of the children are being misdiagnosed with more complex issues than what they are actually suffering from.  Is this because the doctor is aware that the child is adopted and therefore thinks that the child is suffering from an attachment disorder given their background instead of it being a more common case of ADHD?

“It also brings into question whether the clinicians carrying out the assessment fully understand the term ‘attachment disorder’ in the first place.

“More emphasis needs to be put on the issues that adopted parents may face as their adopted child gets older. The professionals who deal with the children need to be fully aware of them to enable the parents to get the most appropriate support.”

Adoptive parents who consider that they need an assessment to enable them to better care for their often damaged children can contact the child care and adoption team at Ridley & Hall on 01484 538421.

Further articles can be found at

Medical Express

The full report can be found in the Journal “Child and Adolescent Mental Health”