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Diagnosing attention-deficit hyperactivity disorder (ADHD) in children involved with child protection services: are
B Klein1, G Damiani-Taraba, A Koster
1Landsdowne Children's Centre, Brantford, ON, Canada; McMaster University, Hamilton, ON, Canada.
Insights
Children in child protection services (CPS) show higher attention-deficit hyperactivity disorder (ADHD) diagnoses. Reassessing ADHD-like symptoms in maltreated children is crucial for accurate diagnosis and care.
Area of Science:
- Child Psychology
- Neurodevelopmental Disorders
- Child Welfare
Background:
- Children in child protection services (CPS) are diagnosed with attention-deficit hyperactivity disorder (ADHD) at higher rates than the general population.
- Maltreatment histories in children can lead to behavioral and attentional difficulties that mimic or overlap with ADHD symptoms.
- Co-occurring conditions such as PTSD, mood disorders, and anxiety are common in children with maltreatment histories.
Purpose of the Study:
- To highlight the overdiagnosis of ADHD in children within the child welfare system.
- To advocate for a reassessment of diagnostic approaches for ADHD-like symptoms in maltreated children.
- To emphasize the need for improved diagnostic and management practices for children in CPS care.
Main Methods:
- Review of existing literature on ADHD diagnosis in children involved with child protection services.
- Analysis of factors contributing to ADHD-like symptoms in maltreated children.
- Comparison of ADHD diagnosis rates across different care settings (group vs. family-based).
Main Results:
- Children in CPS are diagnosed with ADHD and prescribed psychotropic medications more frequently in group care settings compared to family-based settings.
- Behavioral trajectories and symptom presentation can change over time for children in care.
- Existing diagnostic practices may not adequately account for the impact of maltreatment on behavior and attention.
Conclusions:
- A multidisciplinary approach is essential for diagnosing ADHD-like symptoms in children exposed to maltreatment.
- Development of specific practice guidelines for ADHD diagnosis and management in CPS-involved children is needed in the USA and Canada.
- Enhanced education for caregivers, teachers, and child welfare staff regarding maltreatment effects and co-occurring disorders is necessary for improved child well-being.
Abstract:
Children involved with child protection services (CPS) are diagnosed and treated for attention-deficit hyperactivity disorder (ADHD) at higher rates than the general population. Children with maltreatment histories are much more likely to have other factors contributing to behavioural and attentional regulation difficulties that may overlap with or mimic ADHD-like symptoms, including language and learning problems, post-traumatic stress disorder, attachment difficulties, mood disorders and anxiety disorders. A higher number of children in the child welfare system are diagnosed with ADHD and provided with psychotropic medications under a group care setting compared with family-based, foster care and kinship care settings. However, children's behavioural trajectories change over time while in care. A reassessment in the approach to ADHD-like symptoms in children exposed to confirmed (or suspected) maltreatment (e.g. neglect, abuse) is required. Diagnosis should be conducted within a multidisciplinary team and practice guidelines regarding ADHD diagnostic and management practices for children in CPS care are warranted both in the USA and in Canada. Increased education for caregivers, teachers and child welfare staff on the effects of maltreatment and often perplexing relationship with ADHD-like symptoms and co-morbid disorders is also necessary. Increased partnerships are needed to ensure the mental well-being of children with child protection involvement.
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