He Won't Sit Still

This is the complaint of a foster mother who last month had three-year-old Jesse delivered into her care. Not only will he not sit still, he fidgets while she is trying to read him a story and gets up from the dinner table without asking. He frequently bumps into things when he wanders around the house because he doesn’t watch where he’s going. He has trouble falling asleep and often wakes, crying, during the night. He squirms when she is trying to dress him. He quickly loses interest in activities. She is beside herself because he just doesn’t seem to pay attention to her. She tells the caseworker that she thinks he should have medication for ADHD to help him calm down.

Jesse was placed into foster care when he was found roaming the halls of a residential hotel. His mother had left him with a couple that had recently moved into the hotel, saying that she would pick him up later that day. Two days later, she still had not returned.

This is Jesse’s third foster home in the last year. He has been removed from the two previous homes because the foster parents were unable to manage his behavior. If, as is likely, his caseworker is beginning to panic that she will have to remove him and find yet another placement, it is quite possible that Jesse will be taken for an evaluation of ADHD and receive medication to help him “calm down.” 

Photo courtesy of electrictuesday.

Jesse certainly does need help in calming himself. He is, after all, only three years old and needs the reassurance of adults to manage his understandable anxiety. From what little we know of his history, we can reasonably assume that Jesse has had little experience of being comforted by a reliable adult. Not having been soothed by another, Jesse is unable to soothe himself. Not only is Jesse’s three-year-old neurological system developmentally immature, the lack of care and instability he has endured in his young life has likely resulted in his cognitive, social, and emotional development lagging considerably behind what we would expect of a well-cared for child of his chronological age.

Of course Jesse can’t focus. Why would we expect that he could? He’s a kid—a child who has had a traumatic introduction to life. He is a child who has every reason to be anxious—to be constantly on the lookout and on the move. And yet, there is a significant chance that he will be given medication when what he needs is a stable caregiver who can lend him her calm mind and soothing presence. Jesse needs to be held and rocked. He needs to hear lullabies and comforting words. He needs to see smiles and bright eyes when he looks into a loving face. This is how Jesse will develop a mind of his own.

It is likely that Jesse is no more able to control his mind than he is to control his behavior. However, when we rush to medicate children’s brains, we fail to attend to their minds. And when we turn to substances to control behavior we would do well to remember that “a mind is a terrible thing to waste.”

Protecting Young Parents

Many years ago I was asked to make a recommendation to the court about the fate of a toddler whose mother had been raised in foster care. Mother and daughter arrived at my office and immediately headed for a basket of toys. Sadly, the mother was more interested in playing with the toys herself than in helping or enjoying her daughter’s play. Over several sessions over a number of weeks, it became painfully clear that this young woman was totally unprepared for parenting and, sadly, seemed unable to use any help that others or I offered.  If her parental rights were terminated, chances were very good that she would have another baby and end up repeating an evaluation in a matter of a couple of years. If they were not, her daughter would most likely grow up in foster care with intermittent returns to her mother during protracted attempts at reunification and family preservation.

Imagine yourself in a similar situation—a sixteen-year-old girl—with a six-month-old baby. As an adolescent you are developmentally on track if you are working to define yourself as a person in relationship to your family, friends, and community. It takes years of experimentation with different ways of being in the world until the uncertainties of adolescence gradually coalesce into the more comfortable sense-of-self that begins to unfold in early adulthood. That’s all fine for the sixteen-year-old, but what about the baby?

The six-month-old is also trying to figure out how she fits into the world. She is learning to recognize different physical and emotional states and to signal her needs to her caregivers with increasing accuracy. Although she is busy exploring the world, developmentally, she sees herself at the center of the world and, as such, expects that her needs and desires should be first and foremost.

Of course, as a teenager, her mother is also preoccupied with her own needs and desires; this is part of the developmental process of self-discovery. Adolescence is hard; parenthood is hard; adolescent parenthood is even harder. Teen parents who have grown up in foster care and face both adolescence and parenting without parents to guide them are facing a formidable task, indeed. It is hardly surprising that the children of these young parents are five times more likely than other children to enter the foster care system.

Photo courtesy of storyvillegirl

Over the last few years important legislation has recognized the need for late teens and young adults to have the safety net of foster care beyond the age of eighteen. However, that system now finds itself responsible for the young parents who are among that group and there are many; fifty percent of young women in foster care will be parents by the age of twenty-one.

California’s State Senator Leland Yee and the John Burton Foundation are to be congratulated for their work on legislation to help address the unmet needs of this population, including providing subsidized childcare so that parents can complete their education and improve their chances of moving themselves and their children out of poverty. Of equal importance is the provision of education about sexual and reproductive health, which has been shown to decrease the chances of subsequent pregnancies.

As the child welfare system works to educate caseworkers, transitional housing staff, and others working with youth in extended foster care, they must now meet the additional challenge of offering training and support to the adults working to help young parents and their children. It is crucial that the adults charged with supporting young parents have education about the changing developmental needs of infants, toddlers, and preschoolers as well as the needs of their parents, who are entitled to attention to their growth and development along with parenting support. We, along with many others, are attempting to address some of the needs for staff training and support through our knowledge-sharing platform, Fostering Relationships.

These are beginnings. But we must remember that the neither the young parents in foster care nor their children can afford for us to take baby steps. We must make courageous strides if we are to break this cycle of loss.

Nowhere to Turn

A recent story out of Florida is among the more glaring examples of our failure to meet the mental health needs of America’s most vulnerable children—those in foster care. A sixteen-year-old girl who had been sexually molested by her father and then her grandfather was denied mental health services and, instead, referred for treatment of substance abuse.

It’s hardly surprising that a teen with a history of untreated trauma resulting from sexual abuse would turn to street drugs for comfort. Tragically, in this case, there were no facilities for residential drug treatment, while (costly) beds were available for in-patient mental health services. So, with both her Post Traumatic Stress Disorder and drug use untreated the girl was returned to foster care. She promptly ran away as she had before. She is most likely doomed to prostitution, life on the streets, and an early death.

Post Traumatic Stress Disorder (PTSD) is rampant among children in foster care; the incidence is higher among this population than among veterans returning from active duty in Iraq and Afghanistan. Untreated, PTSD can have serious, sometimes irreversible emotional and physical consequences. Children who are so anxious that they can’t stay at their desks have “behavior problems” and are often punished rather than helped. Those who experience the normal jostling in the school hallways as physical aggression and lash out may be seen as perpetrators rather than victims and sent to “anger management.”

Photo courtesy of Pink Sherbet Photography

Children whose nervous systems are so frazzled that they cannot control their feelings or actions disrupt family routines. They don’t sleep well, often keeping other children and parents awake night after night. They shout instead of talking. They see danger around every corner and they can’t soothe themselves or easily accept comfort from others. Because they live at a feverish pitch—acting without the capacity to reflect—they are in danger of inadvertently harming themselves or others.

As a result, foster parents ask to have them removed—whether out of anger, despair, fear or a combination of overwhelming feelings. In the next family, the behavior escalates and the placement ends even more quickly. And so goes the life of a foster child whose original trauma was sexual abuse at the hands of an adult who was supposed to be caring for her.

Untreated PTSD affects not only the child, but also those around her. The children in the classroom who don’t know how to predict or protect themselves from the explosion have reason to be fearful. The other children in the foster families who have their routines and sleep disrupted find themselves more anxious and less able to function well in school. The foster parents who give up and have a child sent away are left to struggle with guilt and self-recrimination.

PTSD is not something that children outgrow. They don’t just “snap out of it.” These children need care from professionals trained to address their emotional needs. When we take children into the child welfare system, we make an unspoken promise to care for them. Failure should not be an option.

Caseworkers Matter

For children who have to leave parents behind and enter foster care the caseworker is one person who can bring stability to their lives. As Alexus Colbert writes about her time in foster care, caseworkers who care can and do make an important difference for children whose lives are filled and uncertainty and loss. 

Alexus also reminds all of us that repeated losses make children wary of forming new attachments as a means of protecting themselves against the pain of being left again. “It is better to have loved and lost than never to have loved at all,” begins to wear thin when the pain of the first loss is compounded by another and yet another.

They, like Alexus, begin to wonder why they should open themselves up to caring about a new person if the chance of that person staying around is small. It is extraordinarily sad that we put foster children into situations where they learn to harden themselves against love by the time they are five or ten or twelve years old.

One of the many unfortunate consequences of shunning relationships with adults is that children become prematurely self-sufficient. They don’t want to risk the vulnerability associated with wanting or asking for something. Sometimes it’s not that they need help—maybe it’s as simple as not asking for or accepting an adult’s offer to read a story or join them on a trip to the park. Relationships are built on small interactions like these.

Photo courtesy of Steve Kay.

Caring exchanges that happen over and over again bind people together. The foster mother who gently braids a child’s hair, the caseworker who brings a favorite snack on visits, the teacher who offers a smile of greeting all tell the child with their actions that they care, that the child is important to them.

The child will come to count on them, to believe in her importance to them. But if one leaves unexpectedly, her belief that she was important may be shaken. It is not only the frequency of the losses experienced by foster children that is disquieting but their unpredictability. For example, elementary school children expect to move on from their teachers at the end of a school year; they can prepare themselves for a parting of the ways. However, it is a very different experience if the teacher leaves with little or no warning in the middle of the school year. That will be a much more unsettling experience for the students.

Unlike the loss of a teacher, which is shared by all of the students in a class, a child’s loss of a foster parent or caseworker is often a solitary experience. Even though the caseworker, like the teacher, may be leaving many children behind, those children may not know or have any contact with each other.

One of the very saddest hallmarks of life in foster care is its solitary nature. Foster children are surrounded by people who have responsibility for bits and pieces of their care. Because there is no single person to keep them in mind, they learn too early keep their minds to themselves. That is a very lonely way to grow up.

We at A Home Within know that we all like the feeling of being in kept in mind. When someone smiles and says, “I’ve been thinking about you,” we know that we have been held in the mind of someone who cares about us and that we don’t actually have to be with that person to continue to exist in his mind. When a child is greeted by a caseworker, or foster parent, or therapist with “You’ve been on my mind,” she can relax a little, knowing that someone cares enough to think about her, even in her absence.

Holiday Sadness

We know that holidays are not always merry and bright. Certainly we are acutely aware of that this year, with the tragedy of Sandy Hook still fresh in our minds as thoughts of the devastation wrought by Hurricane Sandy had barely been absorbed. For many, the holidays will provide a distraction from the enormity of the losses that these events inflicted on families and communities. For others, the holidays will be painful reminders of what has changed and what is gone forever.

Children and families in communities struck by tragedy will be joined in mourning, rather than celebration, this holiday season. The somber mood of the community will reflect the sadness of its members. We are saddened, not only by their losses, but also by the knowledge that this season now will always come with memories of the first holiday without those they loved.

Those children whose losses have been more private may find themselves unsettled by the holidays in a somewhat different way. If everything around them—music, decorations, and bright lights—seems virtually to demand that they share in the holiday cheer, how are they supposed to understand their feelings of loneliness or sadness or longing for better times? Even if the hurt is not of the magnitude caused by the death of a sibling, or parent, or the destruction of one’s home, recent losses can easily disrupt children’s participation in and enjoyment of the holiday season, especially if they feel that there is no one to share their painful feelings.

Photo courtesy of h.koppdelaney.

Parents who have recently separated in preparation for divorce may find that their efforts to maintain holiday traditions do little to calm their children’s anxieties about how they will manage to keep their favorite toys and books in two different homes. Recognizing that their parents are working hard to be cheerful, they may feel as if they have to keep their sadness and anger to themselves or that there is something wrong with them for having those feelings at all.

Children in foster care, especially if they have recently been moved into a new home, may also feel terribly alone and confused during the holiday season. Perhaps they are the only foster child in a family joined by biology, or the newest of several foster children who have been together long enough to understand the rules and workings of the family. If they are still making the psychological transition from their own biological family or a previous foster home they may simply feel too apprehensive and disorganized to join in any festivities, thereby only intensifying their sense of isolation and loneliness.

We wish that all children could share the many joys of the holiday season—the warmth that comes from being with family and friends and the pleasure that comes from giving to others. We are also sensitive to the fact that for many among us, the holidays are a time of feeling set apart from the spirit of the season. Our hearts go out to those whose holiday memories bring more sadness than joy and our earnest wish for them is that they find themselves close to caring adults who will be even more acutely aware of their special fragility during this season.