Prevalence of neurodevelopmental disorders (NDDs) in looked after children (Lac) versus children that are not looked after (non-Lac) and adverse outcomes: A systematic review and Meta-analysis

Abstract Background Looked after children (Lac) continue to attain suboptimal health and social outcomes and have a high prevalence of mental, developmental and behavioural disorders. Limited in research is the exploration of neurodevelopmental disorders (NDDs) in this vulnerable population. This review aims to compare prevalence rates of NDDs in children who are looked after (Lac) versus children not looked after (non-Lac) and identify any impacts on Lac diagnosed with a NDD. Methods Articles were identified in PubMed, ASSIA, IBSS, Web of Science, PsychINFO, Scopus, Psych articles, Social Care Online. Studies that provided primary data on the prevalence of a ND for both Lac and non-Lac under the age of < 25 years were included. Two reviewers appraised the articles using the Joanna Briggs Institute critical appraisal tools. Risks ratio and 95% confidence intervals (CI) using the Mantel-Haenszel random-effects model were used to express and estimate the mean effect, Results Of a total 5,611 records, 12 studies met eligibility. Six studies that met inclusion criteria for a meta-analysis highlight how Attention-deficit hyperactivity disorder (ADHD) RR = 2.69 [1.44, 5.01] and autism spectrum disorder (ASD) RR = 2.23 [1.63, 3.05] have a higher prevalence in Lac compared to non-Lac. The remaining six studies that compared prevalence of NDDs but were not eligible for the meta-analysis are described as a narrative and highlight the adverse outcomes that effect the Lac with a NDD. Findings related to foster care placement, mental health service usage and medication, physical, emotional abuse and criminal justice involvement are discussed. Conclusion Results show that the prevalence of NDDs is higher in Lac versus non-Lac and propose that Lac with a NDD experience more adverse outcomes compared to their non-Lac peers with a NDD. More research is needed to explore the prevalence of NDDs in both populations and further investigate the adverse outcomes that may affect the Lac with a NDD.