Looked after and adopted children are among the most vulnerable in our society and it is well established that they present with a higher prevalence of mental health problems than children who live with their birth family. In their histories, they frequently have birth parents who have lived chaotic lives, some with mental health problems and substance misuse, and have experienced disruptions of care as well as exposure to neglect and/or abuse. However, often when they try to access mental health services, all their problems are formulated as ‘trauma and attachment issues’ with lack of data to support these. This article presents a case study of a 15-year-old boy whose severe difficulties were understood and formulated in terms of ‘attachment problems’ for many years. Neuro-developmental issues, unrelated to his being removed from his birth parents and adopted, had not been considered as the biological factors of the formulation (e.g. genetics and intra-uterus events) were ignored. Because there are no evidence-based interventions for a vaguely defined presentation such as ‘attachment problems’, he was given non-evidenced therapies for years and the parents felt blamed. Understandably, there was then little progress with his difficulties and this in turn had a very detrimental impact on his family, academic and social life. It is recommended that looked after and adopted children have their presentations formulated using a biopsychosocial model that takes into account their complexities to personalise future interventions, just like children who live with their birth parents. It is imperative they stop receiving mental health services where ‘one size fits all’ and that the training of staff working with this group ensures that children’s whole life experiences are understood.

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