Adopted children reported the poorest mental health outcomes across all domains compared to children in foster care, kinship care, and the general population, highlighting substantial disparities in mental health and wellbeing among care-experienced youth.
Key Findings
Results
Children in the general population had better mental health and wellbeing outcomes than all care-experienced peers.
Study drew from the School Health Research Network 2023 Student Health and Wellbeing Survey in Wales, UK
Total sample included 129,761 children across 202 mainstream secondary schools
Analyses compared 103,316 children in the general population against 2,384 care-experienced children
Children aged 11 to 16 completed self-reported measures including the SDQ, SMFQ, and SWEMWBS
Results
Adopted children reported the poorest mental health outcomes across all domains among all groups studied.
Adopted children (n=335) exhibited significantly higher total SDQ difficulties compared to all other groups
Adopted children showed higher internalising and externalising difficulties than general population and other care-experienced groups
Adopted children reported higher depressive symptoms as measured by the Short Mood and Feelings Questionnaire (SMFQ)
Adopted children had the lowest wellbeing scores as measured by the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS)
Results
Children in non-relative foster care had better mental health and wellbeing relative to the other care-experienced groups.
Foster care group comprised 589 children in non-relative foster care
Foster care children had better outcomes than both kinship care and adopted children across measured domains
Ordering of outcomes from best to worst among care-experienced children was: foster care, kinship care, then adoption
Results
Children in kinship care showed intermediate mental health and wellbeing outcomes, worse than foster care but better than adopted children.
Kinship care was the largest care-experienced subgroup with 1,460 children
Kinship care children fared worse than non-relative foster care children across mental health and wellbeing domains
Kinship care children had better outcomes than adopted children across all measured domains
Methods
The study used three validated self-report measures to assess mental health and wellbeing across the groups.
The Strengths and Difficulties Questionnaire (SDQ) measured total difficulties, internalising, and externalising problems
The Short Mood and Feelings Questionnaire (SMFQ) assessed depressive symptoms
The Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS) measured positive mental wellbeing
All measures were youth self-reported
Conclusions
The findings underscore the need for targeted mental health support for care-experienced children across all placement settings, including post-adoption contexts.
Authors note that post-adoption mental health support is a specific gap highlighted by the findings
Policies are recommended to include care-experienced children across all placement types, not only those in foster or kinship care
The study highlights that adoption does not appear to confer mental health protection relative to other care arrangements in this population-level sample
What This Means
This research suggests that children with care experience — including those in foster care, kinship care (living with relatives), and those who have been adopted — have worse mental health and wellbeing compared to their peers in the general population. The study used survey data from over 129,000 secondary school students in Wales to compare these groups on measures of emotional difficulties, behavioral problems, depressive symptoms, and overall wellbeing. Among all care-experienced children, those who had been adopted reported the most difficulties, while children in foster care reported the fewest difficulties among the care-experienced groups.
A particularly notable finding is that adopted children — who are often assumed to have more stable and supportive environments than children in ongoing foster or kinship care — actually showed the highest levels of mental health difficulties across every measure studied. This may reflect the complex early experiences that precede adoption, and the possibility that mental health support tends to diminish or become harder to access after adoption is finalized. Children in kinship care (placed with relatives) fell in between foster care and adoption in terms of outcomes.
This research suggests that mental health policies and support services need to reach care-experienced children in all types of placements, and should not stop at the point of adoption. The findings point to a potential gap in post-adoption support services and call for greater attention to the ongoing mental health needs of adopted children and young people, as well as those in kinship and foster care settings.
Janes E, Paine A, Anthony R, Carter B, Shelton K. (2026). A comparative study of mental health and wellbeing in adopted children, children in foster and kinship care, and the general population.. BMC pediatrics. https://doi.org/10.1186/s12887-026-07104-x