Adoption and fostering

Adopted and foster children are a heterogeneous group. Though children adopted in infancy are over-represented in clinical populations, they show no consistent pattern of difficulties, and infancy adoption acts as a developmental protective factor against a number of risks. Apart from children adopted in early infancy, adopted and foster children share difficulties common to 'looked-after' children. This population is at high risk of mental health disorder, although the level of disorder varies by type of placement, and suffers the consequences of the maltreatment or adversity which necessitated their being 'looked after' in foster or other placements rather than their families of origin. Children placed for adoption after a period in care have been shown to be a particularly challenging group relative to the total population of children leaving care. The number of children adopted from care has risen very substantially in response to Government policy targets, and is set to rise further. Particular psychiatric sequelae of maltreatment, associated with foster children and those adopted from care, include posttraumatic symptoms and difficulties in forming attachments and relationships. Treatment interventions are outlined; it is important to note that there are no universally recognized mode of treatment for difficulties in attachment, no adequate evidence of effectiveness for various techniques which are publicized, and no reason to assume that the often associated behavioural difficulties necessarily derive from attachment difficulties or can be treated via this route. Adequate support for adoptive families is critical to the success of adoption but its provision is patchy.