Children in the United Kingdom who are in Foster Care experience significantly higher rates of mental health difficulties compared to their peers in the general population . Their mental health is often more complex due to the added layers of trauma, instability at home or school and attachment-related difficulties. These challenges can be even more pronounced when the young person is also diagnosed with Autism Spectrum Disorder (ASD).
Young people with Autism who are also in care often experience overlapping vulnerabilities that can affect their communication, behaviours, and social interactions. Adverse Childhood Experiences (ACEs) such as abuse, sexual abuse, neglect, domestic violence, placement breakdown and loss are also strongly associated with poor mental health outcomes and are highly prevalent in this group. Having an increased number of ACEs significantly increases the risk of developing later difficulties such as anxiety, depression and difficulties regulating emotions.
Why are mental health issues common in ASD?
- Social difficulties can lead to isolation or bullying which can contribute to anxiety or depression.
- Sensory sensitivities, such as sound (loud noises, background noise), touch (textures, clothing and tooth brushing), sight (bright lights, busy environments), smell (food, perfumes, smells trigger memories) and taste (gagging, picky eating and avoiding food). All of these things can increase overwhelm, dysregulation and stress. Experiencing these sensory sensitivities can lead to sensory overload which can present as meltdowns, shutdowns or withdrawal. These can impact sleep, appetite, school participating and social engagement.
- Difficulty expressing emotions. This can lead to internalised distress (anxiety, low self-esteem), emotional overload, social struggles, masking emotions and communication barriers (can appear disengaged or avoidant).
What are the challenges or barriers when fostering a young person who has mental health difficulties and ASD?
- ASD can sometimes be missed and misdiagnosed as behavioural difficulties or having attachment issues. However, it is key to note individuals with Autism can also have attachment difficulties. Autism in girls is more easily misdiagnosed or missed due to masking or camouflaging. Girls are often better at imitating social behaviours and hiding their difficulties. Girls with ASD tend to show less overt repetitive behaviours and their special interests often appear socially typical.
- Complex trauma related behaviours such as withdrawal and being hypervigilant can mask or mimic autistic traits.
- If a young person has many placement moves, this can delay or disrupt with assessments, interventions and the continuity of care. This can be for numerous reasons such as poor communication between agencies which leads to fragmented care, thresholds of services and decision making (whether they think it is appropriate to assessment or intervention at that time).
- Some foster carers may lack the training or support needed to recognise and respond effectively to the needs of children with Autism.
- Limited access to neuroaffirming mental health services.
- Difficulty with placements being able to provide appropriate support and structure. Foster placements may not be trauma informed or neuroaffirming which can worsen mental health symptoms.
There are many ways in which foster carers can support young people through mental health difficulties and with their diagnosis of ASD.
- Create a safe and predictable environment, which includes structured routines, clear expectations and visual schedules. It is really important to be patient and consistent in your approaches to establish relationship stability and trust.
- Learn and adapt to the child’s neurodiversity; this can include accessing training for ASD and potential sensory needs, alongside trauma informed care. Responses do need to be tailored to the young person’s communication and emotional needs. It is essential to use calming techniques, such as offering quiet spaces, sensory tools or mindfulness.
- Understand behaviour as communication, think about what the behaviour is telling you as a carer before reacting. It may be useful to keep a diary of the behaviours to identify patterns to reveal any unmet needs or potential triggers.
- Advocate for assessments and services; this includes ensuring SEN support is put in place at school.
- Emotional and relationship support. It is really important to show unconditional positive regard by separating the child from the behaviours they show. Using the PACE model is a good trauma informed approach with young people with complex trauma.
References
Ford, T., Vostanis, P., Meltzer, H., & Goodman, R. (2007). Psychiatric disorder among British children looked after by local authorities: Comparison with children living in private households. The British Journal of Psychiatry, 190(4), 319–325. https://doi.org/10.1192/bjp.bp.106.025023
Author: Sam Hardy, Assistant Psychologist