Vol. 10, No. 1• November 2005

Trauma and children: An introduction for foster parents

It happened suddenly. Sarah and her 10-year-old foster daughter, April, were walking into the grocery store. Out of the blue April shouted, “That’s him!” Sarah looked and saw April staring at a man entering the store just ahead of them. The man, who seemed perfectly ordinary to Sarah, took no notice of them.

Yet April’s body was rigid with fear. She refused to go any further. In a quavering voice she asked if they could please leave. In the car on the way home she cried quietly to herself, unable to explain what had happened.

It was only later, after she had learned about trauma and its effects, that Sarah understood what went on that day.

April was having a trauma reaction.

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All children enter foster care with a variety of memories: some happy, some sad, some worse than sad.

Some foster children, like April, have had experiences so terrifying and disturbing that the memories of these events are problems in and of themselves. After the event has ended, the experience plays itself out repeatedly in their minds. The thoughts, emotions, and feelings of being out of control and threatened are re-experienced, as is the fear, anxiety, and pain associated with the event (ChildTraumaAcademy, 2002).

These intrusive memories are so awful and overwhelming that children struggle mightily to defeat them, to avoid them, to make them go away.

As foster parents you may see these struggles reflected in a host of challenging behaviors: nightmares, regressive behaviors, depression, acting out—the list goes on. To provide proper care for these children, and to make sure that they respond in an appropriate way, foster parents need to understand trauma: what it is, how it impacts child behavior, and how to respond.

Definition, Causes, and Impact
Trauma is a psychologically distressing event that is outside the range of usual human experience, one that induces an abnormally intense and prolonged stress response.

Despite the fact that they are outside the range of usual human experience, traumatic events are fairly common, even among children. A study of children and adolescents in Western North Carolina found that 25% had experienced at least one potentially traumatic event.
Events that can induce trauma include the sudden death of a loved one, assaultive violence (combat, domestic violence, rape, torture, mugging), serious accidents, natural disasters, witnessing someone being injured or killed, or discovering a dead body.

Among foster children physical and sexual abuse are common sources of trauma. Other causes of childhood trauma can include animal attacks (e.g., dog bites), life-threatening illnesses, and prolonged separation from caretakers.

Adversities experienced for an extended period after the trauma (such as a series of different placements or separation from a caregiver) and the supports available to children can influence the severity of their trauma reactions.

With informal support, the majority of trauma survivors recover on their own within a few weeks, though some need longer to heal. For a small minority, however, traumatic events trigger various mental disorders, including posttraumatic stress disorder (PTSD), a particularly serious reaction to trauma.

Left untreated, PTSD can put children at risk for school difficulties, attachment problems, additional psychological disorders, substance abuse, and physical illness. Even if they do develop PTSD, however, timely and appropriate treatment often helps to reduce the severity of stress reactions, or to eliminate them altogether.

Typical Reactions to Trauma
Though trauma reactions may last for weeks or months after the traumatic event they usually show a swift decrease after the direct impact subsides (Goodman, 2002).

Foster parents should be able to spot the following reactions; though these are typical responses to trauma, these behaviors may have causes other than trauma (NIMH, 2001):

Ages 5 and younger: may fear being separated from parent, crying, whimpering, screaming, immobility and/or aimless motion, trembling, frightened facial expressions, and excessive clinging. May regress—return to behaviors exhibited at earlier ages (e.g., bed-wetting, fear of darkness). Children of this age are strongly affected by the parents’ reactions to the traumatic event.

Ages 6 to 11: may show extreme withdrawal, disruptive behavior, and/or inability to pay attention. Regressive behaviors, nightmares, sleep problems, irrational fears, irritability, refusal to attend school, angry outbursts, and fighting are common. Child may complain of stomachaches or other bodily symptoms that have no medical basis. Schoolwork often suffers. Depression, anxiety, feelings of guilt, and emotional numbing or “flatness” are often present as well.

Ages 12 to 17: may exhibit responses similar to those of adults, including flashbacks, nightmares, emotional numbing, avoidance of reminders of traumatic event, depression, substance abuse, problems with peers, and antisocial behavior. Also common are withdrawal and isolation, physical complaints, suicidal thoughts, school avoidance, academic decline, sleep disturbances, and confusion. May feel extreme guilt over his or her failure to prevent injury or loss of life, and may harbor revenge fantasies that interfere with recovery.

What You Can Do
First of all, proceed cautiously. If you observe one or more of the reactions described in the previous section, do not assume that your child is definitely having a trauma reaction. Unless you are a medical doctor, psychiatrist, psychologist, social worker, or other qualified healthcare professional, you cannot make a diagnosis.

If you have concerns, share them with the child’s social worker. If he or she has not already done so and thinks it is warranted, the social worker will be able to have the child assessed by a qualified professional.
However, if you already know your child has been traumatized, consider following these basic guidelines for parents of traumatized children. These suggestions are excerpted from the Child Trauma Academy’s free online course “Surviving Childhood: An Introduction to the Impact of Trauma,” which teaches about the physiological and psychological aspects of trauma, the effects of this trauma on our society, and how you can help.

1. Don’t be afraid to talk about the traumatic event. Children do not benefit from “not thinking about it” or “putting it out of their minds.” If children sense that caretakers are upset about the event, they will not bring it up. In the long run, this only makes the child’s recovery more difficult. Don’t bring it up on your own, but when the child brings it up, don’t avoid discussion. Listen to the child, answer questions, and provide comfort and support. We may not have good verbal explanations, but listening and not avoiding or overreacting to the subject, and then comforting the child, will have a critical and long-lasting positive effect.

2. Provide a consistent, predictable pattern for the day. Make sure the child has a structure to the day and knows the pattern. Try to have consistent times for meals, school, homework, quiet time, playtime, dinner, and chores. When the day includes new or different activities, tell the child beforehand and explain why this day’s pattern is different. Don’t underestimate how important it is for children to know that their caretakers are in control. It is frightening for traumatized children (who are sensitive to control) to sense that the people caring for them are, themselves, disorganized, confused, and anxious. Adults are not expected to be perfect; caregivers themselves have often been affected by the trauma and may be overwhelmed, irritable, or anxious. If you find yourself feeling this way, simply help the child understand why, and explain that these reactions are normal and will pass.

3. Be nurturing, comforting, and affectionate, but be sure that this is in an appropriate context. For children traumatized by physical or sexual abuse, intimacy is often associated with confusion, pain, fear, and abandonment. Providing hugs, kisses, and other physical comfort to younger children is very important. A good working principle for this is to be physically affectionate when the child seeks it. If the child walks over and touches you, return it in kind.

Try not to interrupt the child’s play or other free activities by grabbing them and holding them, and be aware that many children from chronically distressed settings may have what we call attachment problems. They will have unusual and often inappropriate styles of interacting. Do not tell or command them to “give me a kiss” or “give me a hug.” Abused children often take words very seriously, and commands reinforce a very malignant association linking intimacy/physical comfort with power (which is inherent in a caregiving adult’s command to “hug me”).

4. Discuss your expectations for behavior and your style of discipline with the child. Make sure that the rules and the consequences for breaking the rules are clear. Make sure that both you and the child understand beforehand the specific consequences for compliant and non-compliant behaviors. Be consistent when applying consequences. Use flexibility in consequences to illustrate reason and understanding. Utilize positive reinforcement and rewards. Physical discipline is not an option for North Carolina foster parents.

5. Talk with the child. Give them age appropriate information. The more the child knows about who, what, where, why, and how the adult world works, the easier it is to make sense of it. Unpredictability and the unknown are two things that will make a traumatized child more anxious, fearful, and, therefore, more symptomatic. They may become more hyperactive, impulsive, anxious, and aggressive, and have more sleep and mood problems. Without factual information, children (and adults) speculate and fill in the empty spaces to make a complete story or explanation. In most cases, the child’s fears and fantasies are much more frightening and disturbing than the truth. Tell the child the truth, even when it is emotionally difficult. If you don’t know the answer yourself, tell the child you don’t know. Honesty and openness will help the child develop trust.

6. Watch closely for signs of reenactment (e.g., in play, drawing, behaviors), avoidance (e.g., being withdrawn, daydreaming, avoiding other children) and physiological hyperreactivity (e.g., anxiety, sleep problems, behavioral impulsivity). All traumatized children exhibit some combination of these symptoms in the acute posttraumatic period. Many exhibit these symptoms for years after the traumatic event. When you see these symptoms, it is likely that the child has had some reminder of the event, either through thoughts or experiences. Try to comfort and be tolerant of the child’s emotional and behavioral problems. Again, these symptoms will wax and wane — sometimes for no apparent reason. Record the behaviors and emotions you observe and try to notice patterns in the behavior.

7. Protect the child. Do not hesitate to cut short or stop activities that are upsetting or re-traumatizing for the child. If you observe increased symptoms in a child that occur in a certain situation or following exposure to certain movies or activities, avoid them. Try to restructure or limit these activities to avoid re-traumatization.

8. Give the child choices and some sense of control. When a child, particularly a traumatized child, feels that they do not have control of a situation they will predictably get more symptomatic. If a child is given some choice or some element of control in an activity or in an interaction with an adult, they will feel safer and more comfortable and will be able to feel, think, and act in a more mature fashion. When a child is having difficulty with compliance, frame the consequence as a choice for them: “You have a choice — you can choose to do what I have asked or you can choose . . .” Again, this simple framing of the interaction with the child gives them some sense of control and can help defuse situations where the child feels out of control, and therefore anxious.

9. If you have questions, ask for help. These brief guidelines can only give you a broad framework for working with a traumatized child. Knowledge is power: the more informed you are and the more you understand the child, the better you can provide them with the support, nurturing, and guidance they need. Take advantage of resources in your community. While each community has agencies, organizations, and individuals coping with the same issues, you may need assistance finding the expertise that can help traumatized children.

To Learn More
This introduction has only scratched the surface of what we know about child trauma. We encourage you to learn more about this complex and important topic. A good place to start is the Child Trauma Academy’s free online course, which can be found at <www.ChildTraumaAcademy.com>.

Preventing PTSD in Children Adapted from Goodman, 2002

Parental support influences how well children cope after a traumatic event. Birth, foster, and adoptive parents, kin caregivers, and professionals can help children by: Providing a strong supportive presence Modeling and managing their own expression of feelings and coping Establishing routines with flexibility Accepting children’s regressed behaviors while encouraging and supporting a return to age-appropriate activity Helping children use familiar coping strategies Helping children share in maintaining their safety Allowing children to tell their story in words, play, or pictures to acknowledge and normalize their experience Discussing what to do or what has been done to prevent the event from recurring Maintaining a stable, familiar environment

Another valuable resource for foster and adoptive parents on this topic is the article Adopting and Parenting a Child with a History of Trauma by Joycee Kennedy and Frank Bennett, which first appeared in Children and Trauma in America: A Progress Report of the National Child Traumatic Stress Network. To access this full report, go to www.nctsn.org.

References for this article are available by clicking here.

Copyright � 2005 Jordan Institute for Families