PTSD's Impact on Foster Children
Post Traumatic Stress Disorder (PTSD): Long-term Outcomes for Foster Children
We often hear about Post-Traumatic Stress Disorder (PTSD) when soldiers suffer traumatic events in military combat. Trauma from accidents, events, or deliberate actions can cause emotional responses in people of all ages. Some responses may last a short while, and others extend over a long period of time. When people develop long-term symptoms of traumatic stress, it can impact their mental health and lead to a diagnosis of PTSD.
PTSD doesn't discriminate by age. Even infants and young children can suffer from PTSD.
People with PTSD may experience it differently from others. As individuals cope with the trauma they've experienced, they may have anxiety attacks, flashbacks, or nightmares. Most foster children have experienced trauma or even multiple traumatic events. Most commonly, foster children have lost a parent or caregiver, or they've suffered child abuse, neglect, or sexual abuse.
When the Child Welfare System identifies at-risk children, many will enter foster care. Those who have symptoms or a diagnosis of PTSD will receive mental health care provided by their state's foster care system.
The Adoption and Foster Care Analysis and Reporting System (AFCARS) most recent 2021 data shows that nearly 400,000 children are in the foster care system. The average age of a foster child in the United States is 8 years old. Each unique child has their own story about how they came to be in foster care. Each will uniquely face whatever form of hardship or trauma they have experienced.
Foster parents can help create brighter futures for foster children.
PTSD in Our Youngest Children
PTSD affects children and adolescents, as well as adults. The impact of PTSD on kids under the age of seven is particularly different than on adults. Research shows that the type of trauma and the child's age affect the emotional and physical symptoms of PTSD. These factors and a child's developmental level impact their treatment options.
Preschool kids with PTSD show impaired functioning in various areas of their lives. Those diagnosed with PTSD often develop other mental health conditions resulting from the trauma they experience. Examples are Oppositional Defiant Disorder (ODD) and Separation Anxiety Disorder (SAD). These are two, among other complex trauma areas, that call for different treatments for PTSD.
We know that young children are resilient. However, PTSD-related symptoms tend to persist over long periods, especially in the extremely young. Healing from complex post-traumatic stress disorders, particularly after enduring recurrent trauma, is a lengthy process.
Many children in foster care have experienced abusive relationships, either verbal or physical. Others may have endured sexual assault or distress from separation from their families. Some may have had a single traumatic event, while others have suffered repeated traumas over many years.
Causes of Early Childhood PTSD
A child's perception of their trauma exposure impacts their risk for PTSD. A variety of factors define risk on an individual basis.
Studies cited by the National Center for PTSD say that many kids go through at least one trauma. Percentages range from 15 to 43 for girls and 14 to 43 for boys. Of these, approximately 3 to 15% of girls and 1 to 6% of boys develop symptoms of PTSD.
When diagnosing pre-verbal children with a form of PTSD, professionals use the term 'Developmental Trauma disorder.' Like Complex PTSD, repeated trauma from child abuse by a known person is one example of trauma that can cause long-term effects.
Child Abuse
Child services investigates many cases of child abuse each year. This maltreatment can take several forms:
- 7% - Emotional Abuse - Isolation, rejection, excessive criticism
- 65% - Neglect - Failure to provide care, clothing, food
- 18% - Physical Abuse - Intentional bodily harm, physical suffering
- 10% - Sexual Abuse - Forced sexual act(s)
Common estimates among social services are that up to two-thirds of child abuse cases go unreported. An estimated 1,840 children died from abuse and neglect in 2019.
Domestic Violence
A stunning number of children witness violence involving physical, emotional, or sexual abuse. Every year, domestic violence involves about 10% of children. Tragically, in some of these cases, children even witness murder.
Violent or Catastrophic Events
A single traumatic event or violent act can trigger PTSD. Natural disasters are an example. One study focused on 70 kids from ages 3 to 6 who lived through Hurricane Katrina in New Orleans.
Research found that children in New Orleans, whether they stayed or left, were prone to develop PTSD following Katrina. Those affected included 62.5% of children who stayed and 43.5% who evacuated.
Other common PTSD-inducing events include:
- Severe injury or death of a familiar person
- Violent events such as car crashes, fires, or shootings at school
- Suicide of a friend or family member
- Violent acts witnessed within the community
How a child perceives the traumatic experience determines their risk of developing PTSD. Contributing factors are how the child's parents react, how severe the event is, and how close the child is to the event.
Foster Care Trauma
Entering foster care often traumatizes kids, in addition to the hardships they experienced at home. They suddenly find themselves living with strangers in an unfamiliar place. Most foster kids feel a range of emotions that include being scared, alone, and out of control.
Ironically, many feel unsafe without the comfort of familiar family and routines. Displaced and feeling insecure, often children enter foster care without any belongings of their own. Removed from unsafe homes, they often don't get to see or say goodbye to their parents or siblings. Uncertainty and lack of closure create tremendous stress and a sense of loss.
Many foster children lose trust and don't believe any adults will take care of them. They may withdraw and put up barriers between themselves and others. Many of these children lose their innocence and feel worthless and unwanted.
While many foster children rejoin with their biological families, others cannot. Some do not find a resolution to their problems or see justice done. This creates a sense of loss that many kids cannot overcome.
What are the Symptoms of PTSD in Young Children?
Infants react and respond to the emotions of parents or caregivers. Babies who sense distress, anxiety, or anger may react by being fussy or hard to soothe. They may have disrupted sleep or eating, or they may simply withdraw.
Parents' emotions and level of care greatly affect children developmentally between 2 and 5 years old. Kids with PTSD may have perpetual frightening thoughts or memories that make them feel unsafe. PTSD behaviors often seen in these small children include:
- Repeated talking or playing out traumatic events
- Tantrums or angry outbursts
- Tearfulness or excessive crying
- Fears of the dark, monsters, or being alone
- Heightened sensitivity to sound and noise
- Changes to patterns of sleeping, eating, and going to the bathroom
- Clinginess and separation anxiety
- Reverting to thumb-sucking, bed-wetting, or using baby talk
Kids might think that the bad thing they're going through will just disappear and everything will be normal again. They may detach and withdraw from others. It can be difficult to see this type of avoidance in extremely young children since they often internalize it.
How to Treat PTSD in Children
Mental health professionals use several treatments to help infants and extremely young children overcome PTSD. Evaluating circumstances and developing a unique care strategy to fulfill each child's needs is vital. Four common approaches include:
- Directive or Non-Directive Play Therapy
- CBT (also known as Cognitive Behavioral Therapy)
- EMDR (a newer treatment, also called Eye Movement Desensitization & Reprocessing Therapy)
- Relation-based Therapy
Working with the family individually or in support groups is important since PTSD affects everyone close to the child. Sometimes, the event that caused a child's PTSD leads to their displacement from home. In these cases, it's crucial that foster families be a part of the young child's treatment plan.
Providing Trauma Foster Care
How do foster parents support foster children with PTSD? To care for an infant with PTSD, every caregiver must use a consistent, soothing voice and maintain a calm demeanor. Foster parents must earn trust by consistently fulfilling the baby's needs so that babies can develop a healthy attachment.
Foster caregivers must hold infants and young children and give comfort through physical contact. Babies and young children are highly responsive to smiles and warm, steady eye contact.
Be Patient
Older foster children have usually lived in multiple foster homes. Foster parents can support them by inviting them to describe their experiences. Be prepared to patiently answer questions that children may ask time and again. Patient repetition is key.
Stay open to listening to their feelings without pressure. Children need to process their thoughts and feel trust. Each child works on their own timeline. Encourage discussions among the whole family about feelings and what makes each member feel sad, scared, or angry.
When you first welcome a foster child into your home, give them time to get used to being there. As they grow more comfortable, give them age-appropriate family responsibilities so they feel a sense of belonging. Work at your foster child's pace and be sensitive about asking for too much or causing stress.
Patience involves finding ways to offer your foster child comfort and support while ensuring they feel safe. Be open to hugs and cuddles, inviting this comfort only as your child is ready. Work with your child advocate to learn strategies that let your child make these first moves to come to you.
This can be hard for parents who want to give physical comfort. Bear in mind that any form of physical touch may trigger PTSD in children who have suffered abuse.
Communicate
Use age-appropriate language that your foster child understands. Experiment with different methods of communication to understand what works best. Consider alternatives like sign language, drawings, or role-playing using toys as props.
Be Flexible
Be mindful that children often feel withdrawn or numb for the first several weeks in a new foster home. Keep an eye out for signs and symptoms of PTSD.
Children with PTSD may need additional support for other mental health problems, too. Learn about the risk factors and how you can help.
Create Routines
Having structure is important for young children. They find set routines comforting. All kids like to know what to expect on a day-to-day basis. Predictive days are therapeutic for foster kids whose worlds are spinning out of control.
Create a daily schedule that includes mealtimes, chores, bedtime stories, and sleep time. Participate in routines or traditions like singing or saying prayers before meals and sleep.
Give Special Bedtime Considerations
Nighttime or bedtime can increase anxiety for young children who've suffered trauma. Establish a routine of telling a soothing bedtime story or talking with your kids after they are in bed. Give them a comfort item to snuggle with during the night, and welcome them to get you if they feel scared.
Foster Children Need Nurturing Parents
To help children with PTSD, contact a child-placing agency near you. A foster or adoption specialist can provide more information and help you pursue your passion for service.
Caring foster parents nurture children and give a lasting gift of resiliency. Every dependable adult can help a foster child survive their trauma and thrive in the future. Even if only for a short time, the loving care you can give a foster child will mean the world.
Learn more about how to become a foster or adoptive parent in your state today.
