The results of a study done by the Harvard Medical School, the University of Michigan and the Casey Family Program found that children in foster care were twice as likely to suffer from PTSD than other children. This is some alarming information and causes us to ask the question why? Are children coming into the foster care system already traumatized? Are children being traumatized while in the system or is it a combination of both? Whatever the answer it means those working in the system with children need to be aware of this reality and how to best help the children.
What is PTSD?
According to the DSM5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) it is exposure to actual or threatened death, serious injury or sexual violence in one or more of the following ways; directly experiencing the trauma, witnessing it in person, learning that the event occurred to a close family member or close friend, or experiencing repeated or extreme exposure to details of the traumatic event. This is also accompanied by several intrusive symptoms among which are: irritable behavior and angry outbursts with little or no provocation, hypervigilance, exaggerated startle response, problems with concentration, and sleep disturbance. With children there may be frightening dreams and repetitive play in which themes or aspects of the traumatic event are expressed.
There are other disorders with some similar symptoms such as acute stress disorder, adjustment disorders, anxiety disorders, and dissociative disorder.
Why foster children
This information is not meant to be an indictment on the foster care system. Rather it should raise awareness of a problem many children are experiencing so help can be given. The trauma that children are experiencing can occur in their family of origin. There are certainly many violent and dysfunctional families in our society, thus the need for the foster system. It can also occur while in foster care as we have seen through many horrible and extreme stories.
It should not be a surprise that this population is an at risk group given the nature of PTSD. The focus needs to be not on the where but the child and what they have experienced. Wherever the trauma has occurred, children need the proper care to heal and develop into mentally and emotionally healthy adults.
Why some children are more susceptible
Every adult who goes into combat doesn’t end up with PTSD. The same is true for children in foster care. Every person is unique as to their capabilities and mental health before a trauma. Many characteristics come into play for how a child will respond. This would include things like their personality, genetics, environment, family of origin and a very important component called attachment and nurture. This last component along with the trauma is key as to whether PTSD would develop.
When we are born we all need safe attachment and nurture. Attachment is a safe place to belong. A place I feel safe, wanted, loved and accepted for who I am. It is a place where my core nurture needs are met. This is accomplished by how my caregivers (usually this would be parents) treat me, speak to me, react to me and comfort me. They must be present physically as well as emotionally in my life. They should speak kindly, encouragingly and patiently to me rather than yell, be angry or harsh. They will care for and provide my physical needs. They will communicate love through appropriate touch and hugs. They will affirm my personhood, possibilities and abilities so I develop a correct and positive selfimage.
They definitely will not be physically, emotionally or sexually abusive to me. Since many children do not receive this attachment and nurture either before or during foster care it is easy to see why some would develop PTSD or another symptomlike disorder after a trauma.
How to care for such children
Recognizing and properly diagnosing such children rather than just reacting to their symptoms (and perhaps producing even more damaging to them) is essential. This would include proper training for foster parents in PTSD and what symptoms to look for. Another obvious thing to do would be to provide the safe attachment and nurture, which was mentioned earlier. You may not be able to totally heal a child from their past, but you can make a positive difference for the time you have them. It would also be important to get such a child into counseling with someone who is experienced in working with children and PTSD.
Do not overlook the healing power of prayer in your arsenal of treatment tools. Love and prayer don’t sound like cutting edge treatment, but they can be very powerful tools for healing. There are many other forms of therapy than sitting in the therapist’s office. Things such as art, music, animals and play therapy just to name a few are seeing effective results. I remember a college professor saying this in class one day about children, “Always remember this about kids: they grow up and they remember.” His point was to not minimize children, for they will one day be adults and perhaps be in important or influential places shaping our world. They will also remember the people and events of their childhood either positively or negatively. We mold our future world by how we care for and treat our children today.
Dr. John Hawkins, Sr. runs Gateway Counseling Center in Boynton Beach along with his son John Jr. He can be reached by visiting gatewaycounseling.com.