Trauma / Settling VS ADHD?

[LeonardoDaScreachy]

Our daughter was placed with us in the last quarter of 2023.
She's an older child, starting year 2 in September and will turn 7 pretty soon after term starts.
She's settling in really well all things considered and the social workers were all really happy with her attachment and settling progress (we've completed AO now so they're no longer involved) but she has had a really tough time of it and there's been a few extra bumps along the way.

I'm noticing that on her PEP reports / within the feedback we've had from school there's a lot of things that line up with ADHD in girls, and if I look at her behavior objectively then I can certainly see that she does have quite a few of the typical presentations for girls.

Her older siblings, not placed with us, all have diagnosis of ADHD (as well as varying other conditions).

I don't want to confuse trauma and behavior that's part of settling with us, starting her new school, adjusting to everything + the fall out from the extra bumps with ADHD but I also don't want to leave her to struggle any longer than necessary without pursuing a diagnosis.

School are a bit up and down when it comes to help and support. They've got all the resources and aren't afraid to spend the money to get the support in place but they seem pretty rubbish at communication / making the first steps and seem to need prompting a lot. I'm not necessarily confident that if they'd noticed anything they'd speak to us about it / do anything about it.

I just wondered if anybody has any experience of similar / pursuing ADHD diagnosis post placement, or if anybody has any advice?

If relevant the things I have noticed are:

1. Cries easily
2. Easily distracted / but also hyper focuses
3. Messy and disorganized
4. Sensitive to loud noises
5. Easily upset
6. Interrupts others
7. Talks a lot
8. Delayed response when answering you / seems like she doesn't hear you
9. Often struggles to complete a task / gets distracted
10. Makes careless mistakes on tasks e.g. homework and then becomes silly / hyperactive when first pulled up on it then emotional after that
11. Struggles to follow instructions
12. Fidgets a lot
13. Not able to wait her turn
14. Struggles to fall asleep at night

@LeonardoDaScreachy congratulations on your placement and I’m glad to hear that things are going well for you all, especially your DD. What I would say is that there doesn’t have to be a binary ‘choice’ between attachment issues/developmental trauma and/or ASC/ADHD. There are strong heritability factors for both ADHD (up to 80pc) and ASC and it is not beyond the realms of possibility that your DD’s birth parents self medicated and lived chaotic lives due to undiagnosed conditions, like ADHD.

I’m 15 years in now with a teen of 15 and a younger DD of seven, both of whom have had terrible starts to life. DD1 was only diagnosed with ADHD and ASC at the age of 14 and DD2, who is seven, was diagnosed at the age of six. They both have attachment issues (the longer I am in this ‘game’ I don’t really believe that attachment issues/disorders are ‘recoverable from’; instead, we learn to adapt our parenting styles and we learn to manage.

There is significant overlap between the symptoms of attachment disorder and autism and ADHD - and, speaking from personal experience, my elder DD is also diagnosed with neonatal abstinence syndrome as well as being blind so there are other complicating overlapping factors. I have found that the autism and ADHD diagnoses for my two DDs has opened more doors to professionals, funding and support than any diagnosis of attachment difficulties, mainly because professionals, other than those in the adoption-related arena, don’t really understand ‘attachment’. However, there are recognised pathways for the diagnosis of autism and ADHD.

In case the above is TL:DR, my best advice to you would be to pursue the diagnosis/es that secures the best possible support and funding for your DD in every educational setting. It is my belief that every single adopted child will need additional support all through their life and schooling.

Thank you very much for the reply.

I guess up to now I just assumed that with her having spent over quite a while in foster care (most of that time in one, long term placement) that if it was ADHD / ASD that somebody would've noticed before now pre-placement, but the more I think about it the more I think that actually between COVID, a few social worker changes and other stuff it may have actually never been explored or considered.

I guess that was naive on my part, but I have learnt that lesson now!

@LeonardoDaScreachy , you are not making any mistakes, you are settling in to becoming your DD’s forensically-minded advocate and expert! Genuinely, a lot of (not very curious) professionals only ‘see’ attachment when it comes to children removed from their birth families but there can be multiple overlapping factors. Just have confidence that you are the expert and not the teachers who don’t live with your DD. And please don’t forget that girls are proportionally less likely to be diagnosed than boys - because the diagnostic tools are predicated on male characteristics for ADHD and especially autism.

The first thing I’d say is have her hearing checked. My DD was 6 when placed with all of the characteristics you’ve mentioned. After much argument back and forth we discovered she had varying degrees of hearing loss in both ears but had learned to mask so well nobody had noticed. The not quite following instructions and reactivity was because she thought she was doing the right thing only to have got it wrong.

She does have neurodiversity issues but is much less reactive because she can ask people to repeat themselves because she knows she can’t hear.

Our CAMHS neurodevelopmental team basically assess for everything in one long comprehensive assessment so ASD, ADHD, FASD etc. Waiting times are long so it’s worth referring her because if things settle it become clear you can withdraw her but if you wait, she’ll go to the back of the queue. As @EmmatheStageRat says it’s not either or, though you are still early days in placement so you may find CAMHS will want to watch and wait for a while anyway.

Some of it will be her being 6 with a whole heap of trauma and change - it was about 3 years in before I saw the girl my DD has become (now aged 12), it took a long time basically until she had been here longer than she had been anywhere else. With older kids it’s a long game. Do speak to the school about support, my DD has needed different types of support and a very flexible approach from the school.

I agree. There's too much overlap to be able to sort one from the other, especially so early on, and they are not mutually exclusive.

As someone who has made referrals to pretty much every service going in the last 12-18 months, I would advise you not to spend too long thinking about whether to refer or not. Waiting lists are long and you are better on them than not.

The school can put in a referral to Community Paediatrics who in theory can diagnose adhd and autism. In reality they will also have their work cut out unpicking your daughter's symptoms so a diagnosis may not be clear cut. It's worth knowing if your child has adhd as the doctor may be able to prescribe meds to help.

School can also make a referral to occupational therapy. Nhs OT can assess motor skills and they can also recommend some aids for her to use in school like a move and sit cushion and fidget toys. Frustratingly, nhs OTs do not seem to have sensory needs as part of their remit.

So finally, I'd also get in touch with post-adoption support and ask to refer to the adoption support fund to access some sensory integration therapy.

Thank you very much everyone, your replies have been very useful and also given me a lot more confidence!

I would agree to get a diagnosis pathway started, even if just to rule it out. These things take aaages. Let the professionals tell you to wait if they think it necessary, don't try to not burden them and make that choice yourself because imagine you got 2 years down the road and she did have it- she could have had 2 years more medication, input, therapy or whatever.

We have endless medical appointments with our two because we are trying to rule stuff out, which can only be done by the services themselves. So now we know for sure that the oldest can hear us, he is just choosing to ignore us, whereas the youngest sometimes genuinely finds it hard to hear. And the first thing anybody asks is have they had a hearing test, and we can confidently say yes, no problems, so what will you do next doctor?

Don't place any faith in pre placement medical stuff. Ours were a very mixed bag. FCs reported stuff but it was dismissed because they didn't know how to advocate, social workers just read the reports and accepted it was the way it was or that it was just trauma based, doctors weren't au fait with sensory need etc. Nothing was cohesive, and it was only when we started taking them to the GP with notes and records and diaries that stuff was taken seriously.

I'm glad she is settling in well with you, and it sounds like you are ready to advocate for her. Let us know how it goes!

Also, given you said the school aren't afraid to spend money, you can contact the virtual school and put them in touch with the head of your school. The virtual school can put on training in trauma and attachment needs for the teachers at your school.

You probably know that children in Foster care always have a PEP., but once they are adopted it's no longer statutory but you can request the school continue to provide one, if it's useful.

You can also apply for an ehcp if your child needs more support than the school is providing. Referral for an ehcp can be made by either the school or the parent, but the school needs to eevidence what they have already tried and the support that is already in place, so I would get the ball rolling in the other areas first.

@LeonardoDaScreachy

You have had great replies so I won't add too much except to echo that you are doing a great job, learning about your child and what she needs

The only other thing I would say is that children can behave very differently in foster care. My son was with the same family for nearly 4 years. They loved and cared for him very well, I have no issues there, but he was younger, closer in time to the events that led him to care. As the trust came, a very different child emerged