Fostering and Adoption 363good, whereas social skill development was often substantially impaired,
leaving the children seeming rather odd in social situations and unable
to make friends. A further category of children who may be looked after
or adopted is unaccompanied refugees, who often come from war-torn
countries. Currently in England only about 3,000 children are adopted
a year, whereas perhaps two or three times this number might benefit
from it. The process is considered by many to be overly lengthy (typically
taking almost two years from prospective adopters expressing an interest
to their getting a child) and steps are being taken to try to speed this up
and increase the number of children who are adopted.
Psychopathology
Many children being considered for fostering or adoption will have been
subject to neglect and emotional abuse with scapegoating. Some will
have been seriously physically and sexually abused by birth parents or
other members of the family circle. Birth parents are likely to have a
raised prevalence of a whole range of psychiatric disorders, which often
have made it impossible for them to parent adequately; relevant prob-
lems include major psychoses and depression, drug abuse, personality
disorders. Birth parents also have higher rates of intellectual disability
which also makes the parenting task considerably harder. This means
that the children are at risk of emotional and behavioural disturbances,
psychiatric disorders and lower intellectual abilities from both genetic and
environmental causes, and from the interaction of the two. It is often
the case that the particular child who is being put up for fostering or
adoption has a more difficult temperament or more problems than his
or her siblings – sometimes older or younger siblings have stayed with
the family, but the index child has had a particularly bad relationship
with the parents, resulting in total rejection. This may be purely due to
environmental reasons around at the time of the birth, which led the
parent to be less able to cope with the child or scapegoat him or her, but
quite often both the parent and independent observers will note that the
child had a more difficult temperament from the outset.
Genetics and environmental inferences are likely to interact, so that
children with more irritable temperaments and genetic risk factors may be
more sensitive to adverse environments (see Box 33.2). This picture can
lead to a relatively hopeful message, in that despite children with genetic
risks being more vulnerable, if one can make the rearing environment be-
nign at a suitably early stage, one can have a disproportionately beneficial
effect in improving the outcomes for the children and adolescents.
The prevalence of psychiatric disorders in children looked after by
local authorities is very high. The Office of National Statistics survey in
England found that, of all looked-after children (therefore including short-
term fostering), around 45% had a psychiatric disorder, compared with
10% of the total population (see Box 3.1). All psychiatric disorders are