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.
Anglia. She has a special research interest in family placement and has published widely on foster-care, attachment and permanence. Bente Moldestad is a clinical social worker and a researcher in 'The Norwegian Longitudinal Study on Out-of-Home Care' in the Child Protection Unit, Uni Research, University of Bergen. She has published a range of articles on parents of children in foster care and kinship care. Dr Ingrid Höjer is Associate Professor in the Department of Social Work, University of Gothenburg. Her main research interest is child welfare, with a focus on foster care, including foster families, sons and daughters of foster carers and parents of children in foster care. She has published widely in these areas. Her recent research is on young people leaving care. Dr Emma Ward is a Senior Research Associate in the Centre for Research on the Child and Family, University of East Anglia. She has worked on a range of projects including studies of prospective adoptive parents, permanence in foster care and parents of children in foster-care. Her current research is on looked after children and offending. Dag Skilbred is a child welfare worker with main interests in interactive competence, parent counselling and inter-agency work, and has published in these areas. He is now working in the project 'Screening of Children within Child Welfare Service-Inter-Agency Work on Assessments and Services' at the Child Protection Unit, Uni Research, University of Bergen. Julie Young is a Senior Research Associate in the Centre for Research on the Child and Family, University of East Anglia. She has been involved in studies of adoption, the influence of post-adoption contact on all parties, the adjustment of birth relatives to the adoption of their children, fostering and child protection. Dr Toril Havik is a specialist in clinical child psychology and Head of Research at the Child Protection Unit, Uni Research, University of Bergen. She leads the research programme 'The Norwegian Longitudinal Study of Out-of-Home Care' and has published widely on varied aspects of foster care.
This study aimed to investigate the factor structure and external correlates of the constructs Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The following were addressed: First, do our data support the DSM-5 conceptualization of RAD/DSED as two separate constructs? Second, are RAD and DSED distinct from other well-established dimensions of child psychopathology? Third, what are the external correlates of RAD/DSED in this sample? The study sample included 122 foster children aged 6–10 years. Foster parents completed the Strengths and Difficulties Questionnaire (SDQ), and the RAD/DSED-scale from the Developmental and Well-Being Assessment. Child protection caseworkers completed a questionnaire regarding exposure to maltreatment and placement history. Confirmatory factor analysis (CFA) of the RAD/DSED items identified a good fit for a model with a two-factor structure, which is congruent with the DSM-5 definition of RAD and DSED. A new CFA model, which included the RAD and DSED factors together with the four problem factors of the SDQ (emotional, conduct, hyperactivity-inattention, and peer problems), also demonstrated a good fit with our data. RAD and DSED were associated with the SDQ Impact scale and help seeking behavior. This was partly explained by the SDQ externalizing and peer problem subscales. Our findings lend support for the DSM-5 conceptualization of RAD and DSED as separate dimensions of child psychopathology. Thus, the assessment of RAD and DSED provides information beyond other mental health problems.
BackgroundHigh prevalence of mental disorders among foster children highlight the need to examine the mental health of children placed out of home. We examined the properties of the Strengths and Difficulties Questionnaire (SDQ) in screening school-aged foster children for mental disorders.MethodsFoster parents and teachers of 279 foster children completed the SDQ and the diagnostic interview Developmental and Well-Being Assessment (DAWBA). Using the diagnoses derived from the DAWBA as the standard, we examined the performance of the SDQ scales as dimensional measures of mental health problems using receiver operating characteristic (ROC) analyses. Recommended cut-off scores were derived from ROC coordinates. The SDQ predictive algorithms were also examined.ResultsROC analyses supported the screening properties of the SDQ Total difficulties and Impact scores (AUC = 0.80–0.83). Logistic regression analyses showed that the prevalence of mental disorders increased linearly with higher SDQ Total difficulties scores (X2 = 121.47, df = 13, p<.001) and Impact scores (X2 = 69.93, df = 6, p<.001). Our results indicated that there is an additive value of combining the scores from the Total difficulties and Impact scales, where scores above cut-off on any of the two scales predicted disorders with high sensitivity (89.1%), but moderate specificity (62.1%). Scores above cut-off on both scales yielded somewhat lower sensitivity (73.4%), but higher specificity (81.1%). The SDQ multi-informant algorithm showed low discriminative ability for the main diagnostic categories, with an exception being the SDQ Conduct subscale, which accurately predicted the absence of behavioural disorders (LHR− = 0.00).ConclusionsThe results support the use of the SDQ Total difficulties and Impact scales when screening foster children for mental health problems. Cut-off values for both scales are suggested. The SDQ multi-informant algorithms are not recommended for mental health screening of foster children in Norway.
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