Diagnosing attention‐deficit hyperactivity disorder (ADHD) in children involved with child protection services: are current diagnostic guidelines acceptable for vulnerable populations?

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.

ADHD and social work with children and adolescents

“…This co-morbidity can be expected to be particularly strong for child protection populations (cf. Klein, Damiani-Taraba, Koster, Cambpell, & Scholz, 2015). Richards (2013) has in a manner that is of great importance for social work discussed the overlap between ADHD and conduct disorder and refers to a study showing that clinicians blind to the diagnostic status of children saw similar levels of psychosocial problems in children with ADHD and conduct disorder.…”

“…the context of the behaviour) (see Tegtmejer, Hjörne, & Säljö, 2017). Symptoms common in child welfare population may in some cases also be attributed to ADHD when in fact they may reflect other conditions (Howe, 2010;Klein et al, 2015). This issue is surely not only of academic interest; diagnoses with similar symptoms but with different aetiologies may require different treatments (Tegtmejer et al, 2017).…”

“…If other causes for the symptoms are not considered, the symptoms may thus in part remain, even if e.g. ADHD medicine is prescribed (Klein et al, 2015). As Klein et al (2015) point out in a review, the diagnostic guidelines for ADHD are less suitable for children in child welfare whose problems often are multifactorial.…”

A Study of Comparative Clinical and Socio-Economic Characteristics of School-Age Children Screened for ADHD: Implications for Development of ADHD Clinical Care Pathway

“…Many other neurodevelopmental and neuro-behavioural disorders such as autism, developmental speech, motor, coordination and cognitive delays, sleep or sensory integration disorders, each requiring prompt assessment and management may also present as co-morbidities or with overlapping ADHD-like symptoms. ADHD diagnosis should therefore be conducted within a multidisciplinary team and the practice guidelines should prompt healthcare providers to explore all the various social, mental health, genetic, developmental, perinatal and educational factors affecting the diagnosis [29,30].…”

Lead as a Risk Factor for Attention Deficit Hyperactivity Disorder (ADHD) in Children.

“…It has many bases such as neurobiological, neurochemicals, and genetic (Singh et al,2015). It is a lifelong debilitating disorder with many social skill difficulties (Klein et al,2015). It is well known that ADHD in children of school-age, is a serious disorder that can be safely and effectively remediated when early diagnosed and treated (Rappley,2005).Worldwide prevalence of ADHD in school age children is calculated to be about 5% (Polanczyk et al,2007).…”