This article is the first of a three-part series designed to bring awareness to the issue of complex PTSD among foster youth, how C-PTSD affects foster youth who are nearing the age of transition or exit from foster care, and the implications for social workers and other practitioners or adults who care for these vulnerable youth. This first post in the series will provide an overview of the issue that youth in foster care represent a highly traumatized population, which can lead to the development of C-PTSD.
Foster Care and Trauma
A study from Harvard Medical School, the University of Michigan, and Casey Family Programs surveyed 659 adults who were formerly placed in foster care. Many of those studied said they entered foster care because they had been abused or neglected, more than half reported clinical levels of mental illness, and research tells us that 30% of youth in foster care will experience posttraumatic stress disorder (PTSD) symptoms, which is twice the rate of U.S. war veterans (Salazar, Keller, Gowen, & Courtney, 2013).
Foster children, already traumatized by living with abusive or neglectful parents, have been removed from their homes, causing additional trauma. During foster care, they often move repeatedly, which further traumatizes them. The reality of so many moves makes it difficult for them emotionally and psychologically.
All children in foster care have been exposed to some form of trauma simply by being put in foster care, because it means the loss of their birth family, and sometimes friends, schoolmates, teachers, and everything that is familiar. Many have experienced more than one form of trauma, or they’ve experienced ongoing trauma, the lasting effects of which should be acknowledged and understood by adults who care for or work with current or former foster youth.
Angelina is a former foster youth who has endured a great deal of trauma in her life – more than most. Her mother had a mental illness, and when Angelina was just five years old, her mother – who had been severely abused over a two-year period by her second husband – shot her husband just outside Angelina’s bedroom window one night after a heated argument.
That night, Angelina saw her mother arrested and her stepfather wheeled away in an ambulance – events which marked Angelina’s entry into the foster care system. During her foster care years, she lived in 6 different placements, one with an alcoholic family, one in a home that was destroyed by a tornado, one where she endured abuse, and in all of the placements, she experienced neglect.
Some children, like Angelina, have had experiences so terrifying that thoughts of the experiences play again and again in their minds, and these memories can trigger mental disorders, such as anxiety, depression, and PTSD. Untreated PTSD can put youth at risk for school difficulties, attachment problems, additional psychological disorders, and substance abuse.
Angelina’s story is not typical – very few of the youth in foster care experience the number of traumatic events that Angelina reported. However, we do know that youth in foster care are significantly more likely to have experienced violence, such as abuse or neglect. It is estimated that approximately 90% of children in foster care have experienced at least one traumatic event, and nearly half report exposure to four or more traumatic events (Fratto, 2016).
How Does Trauma Impact Children?
Traumatic events have a profound impact on young children. Trauma can cause a detrimental impact on children’s brains, behavior, and ways of thinking. Ongoing trauma disrupts children’s sense of security, safety, and sense of self, and it alters the way they see and respond to people and situations in their lives.
When traumatic events happen during critical periods of a child’s development, “the very core of the person’s being is altered” (Shore, 2019, para 6). Think about Angelina, who experienced multiple forms of trauma, from abuse and neglect to her mother’s mental illness, to witnessing domestic violence, to years of foster care and frequent moves. From an early age, Angelina’s sense of the world and herself was turned upside down by those terrifying experiences.
For many children like Angelina, they develop feelings of fear, distrust, shame, and defeat that shapes their self-concept (Shore, 2019). They may anticipate and expect trauma to reoccur, and they may organize their relationships around the fear of abandonment or victimization.
Research indicates that experiences of trauma in childhood have particularly adverse effects on adolescent self-esteem, school performance, critical thinking, self-regulation, and self-motivation (Fratto, 2016).
Children who have experienced repeated or ongoing trauma may have developed unhealthy habits and behaviors, including increased aggression and disobedience. Maltreatment changes the structure and chemical activity of the brain, resulting in difficulties in emotional and behavioral functioning (Understanding trauma, n.d.). When trauma exposure is ongoing, or long-term, sometimes youth develop complex post-traumatic disorder.
PTSD and C-PTSD
Most of us are familiar with posttraumatic stress disorder (PTSD), a mental health condition that is triggered by exposure to or witnessing a traumatic event, such as a natural disaster, a serious accident, war or combat, or rape or other violent personal assault. Those who suffer from PTSD might have distressing memories of the traumatic event, they might relive the traumatic event as it if were happening again and again, or they might have upsetting dreams or nightmares about the event.
Those who suffer from PTSD may avoid places, activities, or people that remind them of the traumatic event; they may have negative thoughts about themselves or others, feel detached from family or friends, or feel emotionally numb; and they might always be on guard for danger, be easily startled, have trouble sleeping, have angry outbursts or aggressive behavior, engage in self-destructive behavior such as alcohol or drug abuse, or have suicidal thoughts.
Complex PTSD (C-PTSD), while it may have the same symptomatic behaviors as PTSD, stems from chronic, long-term exposure to traumatic events – things like repeated exposure to domestic violence, child abuse or neglect, living in crisis conditions/a war zone, or human trafficking, for example, and it is most often seen in those whose trauma occurred in childhood. Ongoing or long-term exposure to traumatic events in childhood can interrupt the entire course of a child’s psychological and neurological development.
There has been a significant amount of research conducted to find out how C-PTSD affects foster children and the problems it creates. And with each new study, the need for more support for foster children who suffer from the disorder is bolstered.
“We are a society filled with individuals who have been altered negatively by our childhood experiences” (Shore, 2019, para 10). The negative outcomes that stem from childhood abuse, neglect, and foster care, such as the development of C-PTSD, present a call to action for concerned adults.
Further details about how C-PTSD impacts foster children will be discussed in part two of this series and implications for social workers and other adults who work with foster youth (with a particular focus on trauma-informed care) will be discussed in part three.
Change Their Tomorrows
My mission is to provide support, training, and advocacy for those who have experienced trauma. I’m a firm believer that positive interactions children experienced with adults over the course of time can leave lasting impressions and can truly transform lives. If you, too, are passionate about transforming the lives of those who reside in foster care or are former foster youth, or those who’ve experienced adversity of any kind, then read on…
Fratto, C. M. (2016). Trauma-informed care for youth in foster care. Archives of Psychiatric Nursing, 30(3), 439-446.
Salazar, A. M., Keller, T. E., Gowen, L. K., & Courtney, M. E. (2013). Trauma exposure and PTSD among older adolescents. Social Psychiatry and Psychiatric Epidemiology, 48, 545-551. DOI: http://dx.doi.org/10.1007/s00127-012-0563-0
Shore, J. (2019, April 2). The kids are not all right: How trauma affects development. Focus of health. Retrieved from https://www.focusforhealth.org/kids-are-not-alright-how-trauma-affects-development/
Understanding trauma. (n.d.). Retrieved from https://www.adoptuskids.org/meet-the-children/children-in-foster-care/about-the-children/understanding-trauma