Treating Foster Children for Psychological Issues
By Gerald A. Zimmerman, Ph.D.
Many children are placed in foster care as a continuing step in helping them and their families readjust and make changes so they are safe and protected in the home environment. The placement comes about because the Children and Youth authority learns that the children were neglected, physically abused, emotionally abused or sexually abused. Each of these categories has specific definitions. For example, emotional abuse refers to non-physical, gross maltreatment that results in the child being humiliated, demeaned or degraded in some way, or failure to respect the dignity of the child as a worthy human being. The impact of the abuse and neglect of the child has implications that remain for many years to come.
A child who experiences neglect will respond in different ways depending on his characteristics. There are two main types of developing characteristics in children: the active, outgoing type and the reserved cautious type. Drs. Stella Chess and Alexander Thomas have identified these children in a comprehensive developmental study of children. Not all children react the same, and it is the interaction of their environment and their personal characteristics that results in unique responses. For a neglected child, the response may be seen in an outgoing, assertive and bold child to take charge of his experiences and try to prepare meals and comfort the younger children. For a cautious and fearful child, the response to neglect may be to withdraw and become anxious and cower in the corner. With long-term neglect, the patterns become established, and the responses become characteristic of the child, even after the child is given the opportunity to live in a more stable, predictable environment. It takes a great deal of time for the child to make changes and become comfortable and trusting of those around him or her in the new environment.
Regardless of the types of abuse and the child response style, when a child experiences the neglect or abuse, the effect is to lower the sense of self-worth. If the parent is unresponsive to the needs (neglect), the child develops a sense of worthlessness. If the parent is unreliable and inconsistent, the child develops a sense of the environment as unsafe and experiences anxiety. If the child is the victim of sexual or physical abuse, the response is often to fear the adult and to experience the self as weak and ineffective. The different child characters, however, may react to these experiences in different ways. The cautious child may become even more nervous and upset and develop mental health problems, whereas the active child who engages his environment may make attempts to become more aggressive and controlling and develop behavioral problems.
Children who react to the inadequacies of parenthood may develop mental health and behavioral disturbances. The behaviors become routine ways of responding. Some children may develop a sense of inadequacy, demonstrating a dependency more pronounced than would be expected typically at their age. The children may vary in severity of disturbance, but almost all experience some type of difficulty because of the problems identified in the dysfunctional family.
All children experience a great deal of transitional stress when they are first contacted by the children's authority in the county for the purpose of removing them from the home. It is my experience as a therapist for these children that they usually vividly remember the details of the day they are removed. Whether the caseworker comes to the home or the school or the police are involved, the scene is not good for anyone, but is a necessary step in the protection process and also begins the healing process. These transitional episodes can leave an emotional mark on the child, creating apprehension and anxiety, but this is alleviated to a moderate degree once the child becomes familiar and comfortable with the foster parent resource.
Despite the slow development of trust with the new family, behaviors and emotions continue to be present with the child. Often, the children who reacted in a characteristic way in their home of origin will begin to react similarly in the new home, meaning that a child who has become aggressive and demanding in the unstable environment at home will start doing the same thing in the new environment, expecting the parents to react in similar ways to their parents' behaviors. They try to create the environment they knew. It takes a great deal of patience and experience on the part of the foster parents to help the child through this period of adjustment, as the child learns that the needs will be met without these behaviors.
Signs of problems in children can be many and varied. Four categories are identified here:
The anti-social child may initially present as charming and compliant but, after the shock of the transition wears off, will become passive-aggressive, manipulative and resentful and untrusting. He may demonstrate:
• Sadistic behavior and violence
• Compulsive lying and stealing
• Obsessions about sex
• Seeming lack of empathy or conscience
• Oppositional behaviors
• Controlling behaviors.
An overanxious and insecure child may demonstrate panic when separated from those who take care of her. She might show school avoidance, night fears, thoughts about losing a parent and often ambivalence in the relationship with the caregiver. She may demonstrate the following:
• School anxiety
• Trouble falling asleep at night
• Fear of being alone
• Depression when separated from a parent
• Worries about illness, injury or death
• Nightmares with the theme of loss
• Intense love-hate relationships with caregivers.
The asocial and withdrawn child may have become cool and indifferent and show a remarkable lack of anxiety about his isolation from others. She has developed a thick emotional barrier to protect herself from hurt from the agony of separation from those with whom the child has been intimate. The child appears emotionally blunted and inept socially and may have developed a deep distrust of others. The characteristic features of this type of child may be seen in:
• Defects in the capacity to develop relationships
• Lack of strong social desire
• Lack of concern for isolation from others
• Few observed needs for affection and emotional attachments
• Lack of spontaneous emotional expression
• Oblivious to others
• Lack of self-awareness.
The inadequate/dependent child clings to caregivers and exhausts the foster parent with unbounded needs. She can cling to anyone instantly but is usually superficially attached. She requires guidance and constant attention. The child may be submissive and show no signs of rebellion or a difference of opinion. She demonstrates very little confidence and may show:
• Insatiable neediness
• Learned helplessness and low self-esteem
• Lack of interest in negotiating the environment
• Flatness of emotion
• Lack of vitality
• Sense of apathy and futility, and emotional voids.
There are still other children who demonstrate a combination of factors, and, as such, their behaviors may be hard to predict. Children may demonstrate differing degrees of reactions, with some strong in their reactions and others milder. It is likely that most children who are placed in care will demonstrate some reaction to the transition to care and carry over their legacy of responses from the home of origin. It is the struggle of foster parents to help the child become less reactive in a negative way and to learn to trust and feel secure, safe and encouraged to grow through the stages of development to experience self-worth, confidence and an ability to cope with new stress in a meaningful and effective way.
Much of the information provided in this article is from the foster parent-training segment for the KidsPeace Foster Care and Family Program.
Chess, Stella and Alexander Thomas (1996). Temperament: Theory and Practice. Psychology Press, Taylor and Francis Group, New York.
Reistroffer, Mary (1972). What You Always Wanted to Know About Foster Care But Didn't Have the Time or the Chance to Bring Up. Child Welfare League of America, Inc., New York pp 2-3.
Rex, Elizabeth L. A Letter to a Foster Child, in Children Today, Child Welfare League of America, Inc., New York, May-June, 1973, pp 1-2.
Dr. Zimmerman received his Ph.D. in Psychological Studies from Temple University and has been a Clinical Psychologist with KidsPeace since 1982. He performs clinical assessments and conducts group therapy and consultations and works with children in residential treatment and foster care.