Neurodevelopmental Conditions Amongst Care-Experienced Children: A Population-Based Cohort Study Using Linked Health, Social Care, and Education Records from Wales.

Background: Care-experienced children are a vulnerable group with higher exposure to inequalities. Nationwide evidence on the proportion of children with neurodevelopmental conditions (NDCs) and age at diagnosis among those with care experience is limited. Methods: We conducted a retrospective population-based cohort study using linked administrative data from the Secure Anonymised Information Linkage Databank in Wales. NDCs were identified using healthcare and education records among a cohort of children born between 2002 and 2006, followed to age 16. Proportions of NDCs, median age at first recorded NDC and the source of identification were compared between children with and without care experience using chi-square tests and Mann-Whitney U tests. Results: The study included 126,980 children, comprising 123,830 children without care experience, and 3,150 with care experience. 30% of children had a recorded NDC. Proportions were higher among those with care experience compared to those without (5,606 vs 2,888 per 10,000), particularly for learning difficulties, autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD). Among children with NDCs, median age at recorded diagnosis was younger for those with care experience, particularly ASD (7.4 vs 10.3 years). Source of recorded diagnosis differed by NDC and care experience. For ASD, diagnosis was similarly distributed across health and education among those without care experience, whereas among care-experienced children, more were diagnosed through healthcare. Learning difficulties were predominantly diagnosed in educational settings, while ADHD was predominantly identified through healthcare. Conclusion: Care-experienced children have higher recorded proportions of NDCs and are younger at first recording. These findings likely reflect a combination of higher underlying need, differences in opportunities for identification and monitoring, and differences in the continuity of parental support and advocacy available to care-experienced children. Earlier diagnoses would facilitate more timely access to support, highlighting the potential benefits of multi-agency involvement among those with care experience.