25 May 2006 Dear Editor, RE: ARTICLE ‘MENTAL HEALTH OF CHILDREN IN FOSTER AND KINSHIP CARE’ IN NEW SOUTH WALES, AUSTRALIA (MICHAEL TARREN-SWEENEY AND PHILIP HAZELL) AND THE EDITORIAL COMMENT (MAREE CRAWFORD), VOLUME 42, NO. 3, MARCH 2006 My congratulations to Tarren-Sweeney and Hazell for their article highlighting the difficulties faced by children in care in New South Wales, and for Maree Crawford’s comments. Both highlight the multidimensional social, emotional and cognitive problems faced by these children. Each of the four major purposes of the Children In Care Studies (CICS) is laudable, as is Crawford’s conclusion that the carers need ‘support, encouragement, assistance and education’ to provide the essential nurturing relationship for these children. I was dismayed therefore that there is little or no mention of the biological factors that shape these children’s lives. I understand birth parents ‘could not be reliably located in the private study’ (Tarren-Sweeney and Hazell), although there is no discussion as to how important their biological contribution would have been. There is a mention of this in the paragraph titled ‘Gender Differences’, although no attempt was made to tease out the importance of biological and environment risk factors. Does this matter? I think it does. I have been practising as a General Paediatrician for nearly 20 years in a large Regional centre in New South Wales. This has given me the very unique overview of knowing children’s birth families as well as the families into which they have been placed. Often General Paediatricians in my situation have been involved in the removal of the children from their birth family, and may be the only constant carer as the children drift from family to family, as other health-care professionals and even Department of Community Services (DOCS) officers, etc. come and go through their lives. Again and again I have witnessed personality traits in children that mirror their parents’, usually manifesting as acting out behaviours that are often termed Oppositional Defiance Disorder (ODD) and Conduct Disorder. I have seen children perpetrate violent acts serially towards their carers’ (vulnerable) foster siblings, actions that usually see them moved on to the next family. Again, the General Paediatrician remains a constant in terms of provision of medical care, prescription medication, etc. as the children yet again move camp, change schools, General Practitioners and Government workers. Why does it matter? First, focus on nurture, epitomised by the branding of these children with Attachment Disorder, gives the false hope that changing the children’s environment will lead to a change in the child. DOCS habitually do not let new carers know about the previous biology or actions of the child, even when they have acted dangerously in a previous care situation. Stunned carers come to me saying the child has harmed one of their own children or other foster children, having been given no warning that the child had done similar things in the past. Second, when a child continues to display negative behaviours in a placement, the immediate assumption by DOCS has been that it is the environment that is producing these behaviours, which leads to scrutiny of the foster carers, usually with detrimental effects. Children in foster, kinship or adoptive care should be studied in the same way identical twins are studied, as they provide critical information on the nature-nurture debate. We ignore this at our peril, as it can only make the lives of foster and adoptive parents more difficult, and the care of their children more tenuous.
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