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Developmental Disorders, Attachment and the Adoption of Older Children from Foster Care

Children adopted from foster care are at risk for many types of disorders, including attachment disorder; developmental disorders;, health, trauma, behavioral and psychiatric issues; and fallout from birth parental psychiatric illness. Developmental, mental health, and medical and psychological screening and followup is essential for these children following adoption from foster care.

By Martha Henry and Daniel Pollack, authors of Adoption in the United States

It is critical for children in foster care to get routine developmental screenings ad any necessary follow-up. Routine pediatric visits include developmental check-ups, but children may not be seen regularly by a pediatrician while living in foster care. A child's physical and mental functioning may improve if problems are recognized during routine developmental screenings and necessary treatment is provided.

Given that the life of a child in foster care is often filled with separation and loss it is not surprising that behavioral and psychiatric issues are common in these children. While preschoolers in the general population are diagnosed with behavioral problems at a rate of 3-6 percent, 20-40 percent of young children in foster care have similar diagnose (Hochstadt, Jaudes, Zimo, and Schachter, 1987; Leslie, Gordon, Lambros, Premji, Peoples, and & Gist, 2005). Disproportionate rates of mental health problems persist for these children as they age. For instance, children in foster care are sixteen times more likely to receive psychiatric diagnoses and eight times more likely than their peers to take psychotropic medications (Racusin, Maerlender, Sengupta, Isquith, & Straus, 2005). Mental health issues for children in foster care can be exacerbated by lack of access to up-to-date screening and treatment methods. Professionals who work with this population can help children and caregivers understand the consequences of negative experiences on emotional behavioral health.

Early interruption or poor quality of attachment often underlies many of the behavioral problems of children in foster care. Attachment is the ability of a child to form an emotional bond with a primary caregiver. Secure attachment allows children to explore their environment, develop relationships, and form a positive self-image. When this bond is disrupted or formed in an a disordered way, a number of mental health problems results. Children with attachment disorders may show overly vigilant or overly compliant behaviors or display indiscriminate connections to every adult, or they may not demonstrate attachment to any adults. These disordered or disorganized attachments can lead to other adverse outcomes that, left untreated, can persist into adulthood (Harden, 2004; Leslie et al., 2005).

Attachment disorders can result from poor parenting; abuse; neglect and insecure, interrupted, or poor foster placements. Maltreatment itself is associated with insecure attachment organization, poor emotional and behavioral self-regulation, and problems in development of the autonomous self and self-esteem. Toxic and traumatic events directly affect neural and brain development, as neuronal connections do not form well when stress hormone levels are high. These traumas also result in problems such as post-traumatic stress disorder (Leslie et al., 2005; Pearce & Pezzot-Pearce, 2001; Perry, 2001).

Beyond abuse and neglect, other conditions that result in foster placement present additional risk factors. Parental psychiatric illness has been documented in 46 percent of children in state custody; 60 percent of those birth parents were noted to be alcoholics, and 32-54 percent were reported to have problems with substance abuse (Pearce & Pezzot-Pearce, 2001). The effects of these problems include genetic predisposition to substance or alcohol abuse; prenatal exposure to teratogens; and especially dysfunctional parenting, including neglect and time spent living in impoverished environments. Poor supervision, inconsistent discipline, and lack of modeling or positive reinforcement have been found to be factors that contribute to developmental and emotional delays in children.

As children in foster care age, lack of recognition of the need for adequate mental health treatment may lead to further psychopathology. These disordered behaviors can be separated into two types: internalizing disorders (including depression and anxiety) and externalizing disorders, which result in aggressive, destructive, or antisocial behaviors. Children in foster care often receive diagnoses of both types of disorders. The most common problems identified include relational and coping difficulties and school failure. Of the emotional behavior disturbances that cause moderate to sever impairment of the child's ability to function and engage with others, most common are conduct disorders, attention disorders such as attention deficit disorder and attention-deficit/hyperactivity disorder, aggressive behavior, and depression ( Leslie, Landsverk, Ezzet-Lofstrom, Tschann, Slymen, & Garland, 2000). Specifically, adoptive parents may encounter atypical eating behaviors such as food hoarding, rumination, swallowing problems and failure to thrive. Children may also engage in primitive soothing behaviors such as rocking, head banging, scratching, and cutting. Inappropriate modeling or mimicking of adult behavior even if it is abusive is also common (Leslie et al., 2005; Perry, 2001).

It is essential that parent request assistance form professionals trained in the care of children who have experience trauma. Children suffering from trauma do not ordinarily recover with treatment.


Hochstadt, N.J., Jaudes, P.K., Zimo, D.A., and Schachter, J. (1987). The medical and psychosocial needs of children entering foster care. Child Abuse & Neglect, 11(1), 53-62.

Leslie, L., Gordon, J.N., Lambros, K., Premji, K., Peoples, J., & Gist, K. (2005). Addressing the developmental and mental health needs of young children in foster care. Developmental and Behavioral Pediatrics, 26(2), 140-151.

Racusin, R., Maerlender, A.C., Sengupta, A., Isquith, P. K., & Straus, M. (2005). Psychosocial treatment of children in foster care: A review. Community Mental Health Journal, 41, 199-221.

Harden, B. J. (2004). Safety and stability for foster children: A developmental perspective. The Future of Children, 14(1), 31-47.

Pearce, J. W., & Pezzot-Pearce, T. D. (2001). Psychotherapeutic approaches to children in foster care: Guidance from attachment theory. Child Psychiatry & Human Development, 32, 19-44.

Perry, B.D., (2001). Bonding and attachment in maltreated children: Consequences of emotional neglect in childhood. Child Trauma Academy Press, Parent and Caregiver Education Series, 1(4). Retrieved December 27, 2006, from

Leslie, L., Landsverk, J., Ezzet-Lofstrom, R., Tschann, J., Slymen, D., & Garland, A. (2000). Children in foster care: Factors influencing outpatient mental health service use. Child Abuse and Neglect, 24(4), 465-476.

Martha J. Henry and Daniel Pollack are associated with the renowned Center for Adoption Research at the University of Massachusetts. Martha Henry is a developmental psychologist and Daniel Pollack is social work professor and honorary fellow of the American Academy of Adoption Attorneys. This article is excerpted with publisher permission from their excellent overview of adoption, Adoption in the United States: A Reference for Families, Professionals and Students.

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