An Epidemiological Investigation of Inter-Developmental, Biopsychosocial Impairment among Children and Adolescents in Foster Care

Early exposure to chronic maltreatment and other biopsychosocial adversities accounts for high prevalence of developmental impairments among children residing in foster care and other types of statutory out-of-home care (OOHC), including: complex, trait-like mental health difficulties; intellectual disability (ID); and speech and language difficulties (SLD). However, little is known about the characteristics and prevalence of co-occurring mental health difficulties and developmental disabilities among this population - which we refer to as inter-developmental impairment. The present article reports findings from epidemiological surveys of pre-adolescent school-aged children (N = 347) and adolescents (N = 230) residing in foster and kinship care in New South Wales, Australia. Mental health was measured from caregiver-reported Child Behavior Checklist and Assessment Checklist for Children / Assessment Checklist for Adolescents scores; and ID and SLD were reported in a caregiver questionnaire. The proportions of children and adolescents with caregiver-reported ID were 22.5% (78/347) and 30.0% (69/230) respectively, while the proportions with SLD were 21.6% (75/347) and 15.7% (36/230) respectively. While mental health case rates were high among the aggregate child (67%) and adolescent (60%) samples, those with ID and/or SLD were considerably more likely to have clinical-level mental health difficulties compared to those without ID or SLD, with odds ratios ranging from 1.9 to 6.5. The prevalence of inter-developmental impairment (defined as having ID and/or SLD, as well as mental health caseness) among the child and adolescent samples was 23.9% and 28.7% respectively. Children and adolescents with inter-developmental impairment on average had with more complex symptomatology than did mental health cases without reported developmental difficulties. The article discusses mechanisms accounting for inter-developmental impairment among formerly maltreated children residing in foster care, and implications for clinical services.