by Kelly Sullivan •
Human development is phenomenal. We enter this world completely reliant on others for survival, yet eventually we become self-reliant. This is not a smooth process. Instead, development is often a bumpy road with nail-biting detours that can give caregivers gray hair.
Developmental transitions for children and youth in foster care can be even more erratic due to the experiences they have had. Furthermore, complex processes, such as sexual development and development of attachment, aren’t sudden changes that occur at one stage, but instead happen throughout childhood.
Below are some of the trickier developmental hurdles resource parents may face with their child or youth in care, and ideas for how to respond.
We want them to be independent, but getting there can be painful!
Shifting primary attachment figures from your caregivers to your peers is a normal developmental task that typically takes place in adolescence. In fact, on average, the most securely attached children are going to intermittently push away or reject primary caregivers with increasing frequency as they age. If youth don’t do this work, they can have tremendous difficulty forming a healthy romantic relationship as an adult.
Although it’s very important, this stage can be painful for caregivers. The rejection is physical, emotional, and ideological. For example, as teens struggle to find their own identities and belief systems, they may experiment with different identities (e.g., emo, nerd, hipster). This can be a source of conflict with caregivers.
All this is to say, youth in foster care who don’t seem to “listen” to their caregivers may actually be going through the normal process of attachment development.
Yet for youth in care, finding and establishing an identity may be more confusing because they may either have a lack of or negative connection with their biological family or culture of origin. Resource parents often hope youth can put the past behind them, but for most kids in care this may do more harm than good.
That’s because usually things are not that clear-cut. Most children have some positive associations with their families. Additionally, youth trying to understand themselves and their identity often experience a yearning to understand their birth family and why their family was disrupted. Resource parents will promote optimal identify development and better attachment if they simultaneously encourage communication about the youth’s family of origin and provide consistent, sensitive caregiving.
“Routine” medical appointments may not feel that way to youth.
Youth exposed to sexual abuse may be triggered or re-traumatized at routine medical appointments. Additionally, some youth in care have had the experience of a medical exam to determine the probability of abuse. These exams are invasive and can be traumatizing themselves. This means routine medical exams can be very anxiety-provoking.
During all medical exams and procedures, it is important that the youth are informed about how they will be touched and understand the purpose of each procedure. Caregivers can help by finding out what the exam will consist of and explain it to the youth in advance. During the appointment they can also advocate on behalf of the youth, asking medical providers to carefully explain everything to the youth and ask permission before touching.
Preparing youth for medical exams is especially vital starting at age 10. That’s because at this point exams become more invasive and because in adolescence and pre-adolescence our bodies are more sensitive to being touched and exposed.
Please know, some medical providers in North Carolina give youth 13 and over the power to limit a caregiver’s access to medical records. This may catch some guardians and caregivers off guard. Youth in care need to be informed about their rights and the pros and cons of limiting access to their medical records before they make this decision.
Relatedly, older youth are often examined without a caregiver present. While this ensures privacy, youth may be unprepared to talk about their needs. For example, they may want contraceptives, but be too timid to ask. Access to contraceptives can be important for youth in care, since they are twice as likely to become pregnant by age 19 than youth not in care (Courtney, et al., 2007). Helping youth advocate for their needs in situations like these promotes their social and emotional competence, which is a key protective factor.
Is this sexualized behavior or curiosity normal?
Sexual development begins early. Children age five and younger find touching their private parts comforting. Curiosity about others’ private parts begins around the same time.
You may be surprised to learn that the current thinking on talking to children about sex and sexual development is, if the need for conversations hasn’t surfaced before then, age “8 is great!”
Sexual development may be complicated if a child has been sexually abused or exposed to inappropriate sexual content. It is also important to know there is some evidence children who have been sexually abused begin puberty earlier (Noll, et. al., 2017).
Providing guidance and support to children about sexual development can be tricky for any parent. To be as helpful as possible to children in care, resource parents should become knowledgeable and “askable” on this topic. When parents show discomfort with normal curiosity about sex and private parts, children may feel shame and be less likely to seek information from adults.
Resources like the one in the one below can be critical for determining whether behaviors are normal or warrant assessment and treatment. Resource parents will also benefit from using books with their child or youth that explain sex and sexual development. Some of these use a light-hearted tone that can help make conversations more comfortable. Additionally, rather than having “the talk,” children and youth will benefit most from multiple conversations over a span of years.
Understanding Children’s Sexual Behaviors:
What’s Natural and Healthy by Toni Cavanaugh Johnson
An excerpt from the introduction:
When a child (under age 12) is engaging in sexual behaviors it is sometimes difficult to decide when the sexual behavior is natural and healthy and when it may be an indication of some distress or disturbance. This booklet provides a definition of natural and healthy childhood sexual behavior and describes how to develop these behaviors in your child. A section describes how to respond to children’s sexual behaviors in order to promote good boundaries. Twenty characteristics of problematic sexual behaviors in children are described along with information on how these problematic sexual behaviors are developed. Charts describe children’s “natural and healthy” sexual behaviors, behaviors “of concern,” and those in need of professional evaluation. Information is provided on how and where to look for help if an evaluation seems warranted. A continuum of childhood sexual behaviors, from natural and healthy to children who sexually offend, is described. (Publisher: Neari Press, 2015).
Kelly Sullivan, PhD, a Licensed Psychologist, is Director of Mental Health Services at the Center for Child & Family Health and an Assistant Professor at Duke University Medical Center.
