Mental disorders in foster children: a study of prevalence, comorbidity and risk factors

Stine Lehmann,Odd E Havik,Toril Havik,Einar R Heiervang

doi:10.1186/1753-2000-7-39

Stine Lehmann, Odd E Havik + Show 2 more

Open Access

https://doi.org/10.1186/1753-2000-7-39

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Abstract

BackgroundThe aim of this study is to examine the prevalence of mental disorders in 6- to 12-year-old foster children and assess comorbidity and risk factors.MethodsInformation on mental health was collected from foster parents and from teachers using Developmental and Well-Being Assessment (DAWBA) Web-based diagnostic interview. Child welfare services provided information about care conditions prior to placement and about the child’s placement history.ResultsDiagnostic information was obtained about 279 (70.5%) of 396 eligible foster children. In total, 50.9% of the children met the criteria for one or more DSM-IV disorders. The most common disorders were grouped into 3 main diagnostic groups: Emotional disorders (24.0%), ADHD (19.0%), and Behavioural disorders (21.5%). The comorbidity rates among these 3 main groups were high: 30.4% had disorders in 2 of these 3 diagnostic groups, and 13.0% had disorders in all 3 groups. In addition, Reactive attachment disorder (RAD) was diagnosed in 19.4% of the children, of whom 58.5% had comorbid disorders in the main diagnostic groups. Exposure to violence, serious neglect, and the number of prior placements increased the risk for mental disorders.ConclusionsFoster children in Norway have a high prevalence of mental disorders, compared to the general child population in Norway and to other societies. The finding that 1 in 2 foster children presented with a mental disorder with high rates of comorbidity highlight the need for skilled assessment and qualified service provision for foster children and families.

Highlights

The aim of this study is to examine the prevalence of mental disorders in 6- to 12-year-old foster children and assess comorbidity and risk factors
Demographic characteristics and associations between possible risk factors and mental disorders were analysed for the subsample with information from both Developmental and Well-Being Assessment (DAWBA) and the child welfare questionnaire (n = 219)
No differences between children with DAWBA completed by both carer and teacher (n = 141) and children with DAWBA completed by only one informant were found regarding prevalence of Any disorders, Emotional disorders, Attention Deficit Hyperactive Disorder (ADHD), Behavioural disorders or Reactive attachment disorder (RAD)

Summary

Introduction

The aim of this study is to examine the prevalence of mental disorders in 6- to 12-year-old foster children and assess comorbidity and risk factors. In Western societies, the number of children placed out of home converged at approximately 5 per 1000 in 2006-2007 [1]. In Norway [2], as in most western societies [3], parental neglect endangering a child’s development and health is the primary reason for out-of-home placement, and families receiving services from the child welfare system are often characterised by low socioeconomic status [4]. Child welfare services in Norway are typically family-oriented, emphasising voluntary and preventive home-based interventions. After a family’s first contact with child welfare services, children continue to stay, on average, 3 years with their biological families receiving home-based services, before they are placed out of home [5]. Symptom checklists do not take into account comorbidity rates

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