title: 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.
authors.affiliation: Landsdowne Children's Centre, Brantford, ON, Canada; McMaster University, Hamilton, ON, Canada.
authors.forename: B
authors.initials: B
authors.lastname: Klein
authors.forename: G
authors.initials: G
authors.lastname: Damiani-Taraba
authors.forename: A
authors.initials: A
authors.lastname: Koster
authors.forename: J
authors.initials: J
authors.lastname: Campbell
authors.forename: C
authors.initials: C
authors.lastname: Scholz
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000453:epidemiology; D002648:Child; D002649:Child Abuse / Q000523:psychology; D002669:Child Welfare / Q000523:psychology*; D004363:Drug Utilization / Q000706:statistics & numerical data; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D011619:Psychotropic Drugs / Q000627:therapeutic use; D035862:Vulnerable Populations / Q000523:psychology*
chemical_list: D011619:Psychotropic Drugs
keywords: ADHD diagnosis; child protection services; multidisciplinary practices; overmedicated