“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 Evidenc

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.