May 2015 is both Foster Care Month AND Mental Health Awareness Month. This spring we’ve seen a lot of attention to the mental health needs and well-being of foster youth, whether talking about ways to safely reduce the use of psychotropic medications (as I discussed in a previous post), or about the related need to recruit and support relatives, foster parents, and community members to create an essential network of support and healing so that all foster youth have a chance at a happy, healthy future.
It’s a hopeful time when we’re shifting our thinking from drugs to relationships, as relationships are where healing happens. The simple fact is that by the time children come into foster care, they’ve already experienced extraordinary disruption and trauma. For far too many children in foster care, their first experience of trauma was right at the start of life – sometimes even before birth. For all children, but perhaps especially for infants, physical, cognitive, social, and emotional development are intertwined, and trauma can have pervasive effects across domains.
Brain development in infancy and early childhood lays the foundation for all future development. Experiences teach the brain what to expect and how to respond. When experiences are traumatic, the pathways getting the most use are those responding to the trauma; this reduces the formation of other pathways needed for adaptive behavior and learning. Trauma in early childhood can result in stress and anxiety, speech and language delays, and impaired emotional regulation.
Infants who experience trauma often become withdrawn or distressed, as they develop a sense that the external environment, including their caretakers, is unable to provide security and relief. As a result, their responses can be unpredictable – crying when held, content when alone for hours. They will stop sending signals or send disorganized messages because they don’t know which cry or look will get adults to give them what they need. As for anyone, when inconsistency becomes a defining feature of their experience, infants become confused and overwhelmed.
Healthy infants gain confidence that their caregivers will help them manage periods of discomfort or distress, and are progressively more able to cope with these states in a consistent and predictable way. But when caregivers are emotionally absent, inconsistent, violent, or neglectful, infants often respond by becoming withdrawn or distressed and can develop a sense that the external environment, including caretakers, are unable to provide relief. As a result, they experience excessive anxiety, anger and frustration, and unfulfilled longings to be taken care of. These feelings may become so extreme as to cause dissociative states.
Most fundamentally, trauma refers to an event that overwhelms the child’s capacity to integrate it. This means that children can’t comprehend traumatic events—they don’t understand what has happened to them. We often talk about traumatized children being “flooded” with feelings—it’s not just that their emotions feel too big to manage, but that the feelings seem to come from nowhere and without warning. While infants can’t articulate these states, a committed caregiver can recognize when a baby is overwhelmed, provide soothing and reassurance, and reestablish consistency in the external environment that over time decreases distress and allows for development.
Janelle was six months old when she entered foster care. Her mother had asked neighbors to care for Janelle for a couple of hours, but when she didn’t return after two days, they called the police. Janelle was placed with an experienced foster mother, who described her as listless with little interest in anything around her. Initially, when her foster mother tried to hold her, Janelle stiffened and turned away from her gaze. Because her foster mother thought that Janelle was frightened by direct eye contact and hadn’t learned how to accept soothing from an adult, she put Janelle in a sling so that she could hold her close in a way that allowed Janelle to look away from her easily. With Janelle bundled to her chest, her foster mother carried on her usual daily routines. Janelle went with her as she ran errands, visited with friends, and prepared meals. Sometimes she sang to her and sometimes she talked softly about what they were doing. She noticed that Janelle gradually began to relax and would glance at her face while she was changing or feeding her. One day, after about two weeks, Janelle held her foster mother’s gaze for a few seconds and smiled, and her foster mother knew that she had turned an important corner in gaining Janelle’s trust.
Janelle’s story reminds us that trauma that occurs in the context of relationships can only be helped by relationships. This may seem like common sense, but I want to emphasize the point—children and youth suffering from trauma can only by helped in the context of supportive relationships. One of the paradoxes of working with children who have been traumatized by relationships is that they are then afraid of the very thing that could help them—a healthy relationship with a caring adult.
As we think about how to support foster youth during Foster Care Month, I hope we’ll all commit to learning about the impact of trauma, and remember that anyone can learn to support healing through healthy relationships.
Dr. Toni Heineman is the Executive Director of A Home Within.