Children in foster care are often among the most vulnerable members of society. But new research suggests that this group might be even more fragile than we knew. A study by the Centers for Disease Control and Prevention (CDC) has found that rates of children in foster care diagnosed with attention deficit hyperactivity disorder (ADHD) towered above rates of children not in foster care.
The study, to be presented at the American Academy of Pediatrics 2015 National Conference & Exhibition in Washington D.C. on Oct 26, reviewed Medicaid claims from 2011. According to the data, children (ages 2-17) in foster care were three times more likely than children not in foster care to have a diagnosis of ADHD.
Moreover, about half of children in foster care had a diagnosis in addition to ADHD, such as depression, anxiety, or oppositional defiant disorder. Only a third of ADHD children not in foster care had another disorder.
The fact that more children in foster care had ADHD wasn’t surprising to mental health experts. “Children in foster care may be more likely to experience the risk factors that we know are associated with ADHD,” says the CDC's Melissa Danielson, who adds that "unstable home environments, past trauma, neglect, or genetic predisposition" can all play a role in the expression of the condition. In fact, ADHD rates, she says, are generally higher among children in Medicaid compared to children with private insurance.
Some researchers have speculated that this is because ADHD drugs, being available through Medicaid, are often the first line of attack when a kid from a low-income family is unruly.
The picture painted by the study wasn’t all disheartening. Despite disproportionate rates of ADHD diagnosis, kids in foster care appeared to be connected with sources of well-recommended treatment.
Children in foster care were as likely as those not in foster care to be treated with
medication for ADHD. And kids in foster care were more likely than those not in foster care to use psychological services as treatment for ADHD. About 3 out of 4 children with ADHD in foster care received some psychological care in 2011.
Danielson, lead author of the study, said the findings on treatment were promising, "especially since behavior therapy is recommended as the first-line treatment for preschoolers with ADHD and is preferred in conjunction with medication as treatment for school-aged children with ADHD.”
The current research offers some insights into treatment delivery in the future: “As we work to improve the quality of care for children with ADHD, it will be important to consider the needs of special populations, including foster care,” says Danielson.
A more fleshed out understanding of the needs and characteristics of special populations will allow therapists and clinicians to better serve them. The researchers hope findings from the present study remind those working with children in foster care to take into consideration the relationship between past trauma and the expression of ADHD symptoms. The study also illustrates the need for those who treat these kids to look for other conditions that often show up alongside ADHD. Danielson says this information is key “both in the diagnosis and treatment of the disorder."