Adopted children’s mental health needs beyond attachment and trauma: A comparison of social work and mental health conceptualisations

Adopted children are likely to present with a wide range of common mental health issues requiring assessment and therapeutic support. In England the commissioning of therapeutic support is usually conducted by non-mental health professionals. The current study compares the mental health concerns raised in 153 consecutive referral letters from post-adoption social workers against the diagnoses subsequently identified by a specialist mental health clinic for adopted and fostered children. The social workers referred appropriate cases for specialist assessment, with an average of just over two psychiatric diagnoses per child identified in clinic, but there was low agreement between the mental health issues raised in the referral letters and the corresponding clinic diagnoses, particularly in relation to attachment and trauma issues. Most common amongst a wide range of conditions identified ( N = 16) in the clinic were behavioural problems (66.0%), ADHD (61.4%), autism (26.1%) and anxiety diagnoses (23.5%). A minority of children received either post-traumatic stress (12.4%) or attachment-related (0.6%) diagnoses. Notably, when free to choose referral issues for further assessment, social workers also rarely identified issues with attachment (21.6%) or trauma (8.5%). Discussion considers the barriers to a shared understanding between social workers and clinicians regarding mental health issues in adopted children. These challenges are especially important in England where the study was conducted because contrary to the evidence base adoption support has since been restricted to address only issues of attachment and trauma, which were both minority issues in social workers’ referrals, rarely diagnosed and indicated little shared understanding between professionals.