Adoption and fostering

Children adopted in infancy do not generally stand out from community samples with regard to rates of disturbance. Foster children are at high risk of psychiatric difficulty, as are children adopted after infancy from the care system. Both groups are likely to have suffered abuse and/or neglect before entering care, as well as losses and discontinuities of carer. Post-traumatic symptoms, and difficulties in forming attachments and relationships, are the mental health difficulties most particularly related to these earlier adversities. Systematic evaluation of the various treatment approaches to attachment difficulty is lacking, but certain approaches are clearly contra-indicated. Support for adoptive and foster parents of these children is an essential part of their treatment.