Attachment disorders versus more common problems in looked after and adopted children: comparing community and expert assessments

BACKGROUND: Attachment disorders in adopted and fostered children may be overdiagnosed and could obscure more common disorders. METHODS: A case note review of 100 referrals to a specialist adoption and fostering service compared community referrals with the specialist assessments of attachment disorders. RESULTS: Attachment disorders were identified four times more often in community referrals versus the specialist service, but this only partly explained the significant under-identification of more common disorders in the community, especially for neurodevelopmental factors and conduct disorder by up to 10-fold. CONCLUSIONS: The relevant practice parameters are discussed and implications for service models for adopted and fostered children reviewed.