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Mental health of infants in foster care It is now well established that children in foster care are at increased risks of experiencing mental health problems, for example, Ford et al1 described findings from 1453 looked after and accommodated children in a sample of over 10 000 children aged 5–15 years and found that 46.4% of the accommodated children received a diagnosis compared with 8.5% of the general population. Our team2 conducted a systematic review examining the way child characteristics affected child outcomes from care and found that, of the studies which found an effect of age on outcome, three-quarters found more positive outcomes, in terms of finding a permanent placement, for children who entered care at an earlier age. It was, therefore, of interest to see whether very young children were already showing higher levels of mental health problems than their peers. We recruited 60 participants aged between 12 and 24 months. Twenty were children who had recently entered a period of foster care (50% male, mean age 18.8 months), while the remaining 40 were children from the general population matched for age and gender with the in-care sample (50% male, mean age 18.4 months). The children in the foster care sample had been in care for between 5 and 21 weeks, recruited through an ongoing randomised controlled trial ( show/NCT01485510?term=new+orleans& rank=1). Children from the general

population were recruited through nurseries and local council-run sessions aimed at parents with young children (eg, ‘Bounce and Rhyme’). All consenting parents and carers were asked to complete the Infant Toddler Social Emotional Assessment Scale: a 166-item questionnaire completed by the primary caregiver with acceptable test-retest and inter-rater reliability.3 It provides an assessment of the child’s social and emotional development and any behavioural delays. It covers four domains; externalising, internalising, dysregulation and competence. Each domain has an ‘of-concern’ cut-off point, which provides a guide for clinicians to identify areas which warrant further investigation. Fifty per cent of our in-care sample scored within this range in at least one domain. By comparison, 23% of the normative sample scored within this ‘of-concern’ range in at least one domain. We can see that even these very young children in foster care are showing higher levels of problems compared with the general population, but they are, arguably, not as different from their peers as we see in studies with older children. Ford et al1 found that those in foster care were about five times more likely to have a diagnosis than the general population, whereas our sample of infants are only twice as likely to be showing clinically concerning scores as their peer group. While this study should be replicated, these young infants are not apparently suffering from the same levels of mental health problems as compared with their peers when entering care as seen in older fostered children—emphasising the

importance of early intervention for maltreated children. Rachel Pritchett,1 William McKinnon,2 Christopher Gillberg,3 Helen Minnis1 1

University of Glasgow, Yorkhill Hospital, Glasgow, UK University of Strathclyde, Glasgow, UK 3 University of Gothenburg, Gothenburg, Sweden 2

Correspondence to Rachel Pritchett, University of Glasgow, Caledonia House, Yorkhill Hospital, Dalnair Street, Glasgow G3 8SJ, UK; Rachel.pritchett@glasgow. Contributors The in-care sample data was collected by RP, the normative sample data was collected by WM. HM is the PI for the larger RCt which this is a part of, and together with CG they designed this study and supported data collection. All authors contributed to the write up. Competing interests None. Ethics approval West of Scotland NHS Research Ethics Committee five and NHS Greater Glasgow and Clyde (Research and Development Committee). Provenance and peer review Not commissioned; internally peer reviewed. To cite Pritchett R, McKinnon W, Gillberg C, et al. Arch Dis Child Published Online First: [ please include Day Month Year] doi:10.1136/archdischild-2014307086 Accepted 29 August 2014 Arch Dis Child 2014;0:1. doi:10.1136/archdischild-2014-307086




Ford T, Vostanis P, Meltzer H, et al. Psychiatric disorder among British children looked after by local authorities: comparison with children living in private households. Br J Psychiatry 2007;190:319–25. Pritchett R, Gillberg C, Minnis H. What do child characteristics contribute to outcomes from care: A PRISMA review. Child Youth Serv Rev 2013;35:1333–41. Carter AS, Briggs-Gowan MJ, Jones SM, et al. The infant–toddler social and emotional assessment (ITSEA): factor structure, reliability, and validity. J Abnorm Child Psychol 2003;31:495–514.

Arch Dis Produced Child Month 2014 0 No 0Publishing Group Ltd (& RCPCH) under licence. 1 Copyright Article author (or their employer) 2014. byVolBMJ

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Mental health of infants in foster care Rachel Pritchett, William McKinnon, Christopher Gillberg and Helen Minnis Arch Dis Child published online September 17, 2014

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Mental health of infants in foster care.

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