Foster care is a temporary placement within the United States for children who cannot live with their families. In a policy article on Spectrum (https://www.spectrumnews.org/opinion/viewpoint/many-children-autism-end-foster-care/) it was reported that children with autism are 2.4 times more likely to enter foster care than typically developing children. By comparison, in the case of intellectual disability, the likelihood is only 1.9 times higher. For a majority of autistic individuals removed from their families challenging behaviors may have made them difficult to manage at home. Under these circumstances the caregiver’s inability to cope is taxed by the child’s behavioral problems. Other reasons may include neglect, drug/alcohol/sexual abuse, physical violence, inadequate housing, and the parent’s death or incarceration. In many cases impaired parental skills denote adversity passed from generation to generation, e.g., homelessness, mental health, limited education, and domestic violence.
While enrolled in a foster care program, children are placed in the care of specially trained caretakers and automatically enrolled in the Medicaid program. Unfortunately, not all caretakers receive adequate training and many disabled children in foster care will lack the special educational, vocational and mental health care that they need.
In the United States 4.1 million families are reported to Family Services each year. 60% of the cases are accepted and 20% of the cases are fostered; that is, approximately some 670,000 children per year. These children may be separated from their families if there is “imminent risk of harm”, to themselves or others. Imminent harm makes reference to threats to either physical or mental health. Since protective action should be taken rapidly, the charge of imminent harm must be substantiated within 72 hours. Case workers are assigned to each case; however, only law enforcement agents can urgently remove a child from his/her family. Of the 230,000 children annually removed about 1/3 are placed with a relative or kin.
Approximately 6% of children in the US are placed in foster care! The average stay is 20 months but 6% of children spend more than 5 years under this guardianship arrangement. This is a big portion of a child’s life especially when they are so young. More strikingly, children with autism tend to stay in foster care 1.6 times longer that other children. In this setting the children remain vulnerable to physical, mental and sexual abuse.
In the history of autism Leo Kanner is usually given the title of the founding father of child psychiatry. Kanner saw the dangers of institutionalization and waged a valiant war against the same favoring those approaches that promoted socialization and acceptance (Kanner, 1971). Kanner deplored that lack of available institutions for youngsters in need of residential and psychiatric care. For a significant number of patients this required their being sent to state hospitals. Kanner surveyed figures for admission to state hospitals for patients under 15 years of age and, in many instances, criticized the credence of the admission diagnosis and necessity for hospitalization (Kanner, 1965).
It is unfortunate that problems related to institutionalization and foster care have not changed throughout the decades ensuing Kanner’s advocacy efforts. The outcome for these children is depressing. Many end up within the legal system, unemployed, and/or homeless. We need to train social workers within the foster care system to recognize the symptoms of autism. Failing to diagnose these children means that they won’t receive adequate care even for those cases where the same is available. For the majority of autistic children, adequate treatment means going beyond applied behavioral analysis. We need to strive for permanency in placement. In addition, we also need to target resources, facilitate service delivery, and provide for long-term monitoring of the educational, vocational and mental health care that autistic children need.
For those interested in the subject you may enjoy reading the following blogs:
1) Kanner L. The integrative aspects of ability. Acta Paedopsychiatrica 38(5):134-44, 1971.
4) Kanner L. Children in state hospitals. American Journal of Psychiatry 121:925-927, 1965.