Understanding Responses to Foster Care: Theoretical ...

Journal of Human Behavior in the Social Environment, 21:363–382, 2011 Copyright © Taylor & Francis Group, LLC ISSN: 1091-1359 print/1540-3556 online DOI: 10.1080/10911359.2011.555654

Understanding Responses to Foster Care: Theoretical Approaches BARBARA RITTNER School of Social Work, University at Buffalo, Buffalo, New York, USA

MELISSA AFFRONTI Coordinated Care Services, Inc., Rochester, New York, USA

REBEKAH CROFFORD Social Work, Roberts Wesleyen University, Rochester, New York, USA

MARGARET COOMBES School of Social Work, University at Buffalo, Buffalo, New York, USA

MARSHA SCHWAM-HARRIS School of Social Work, Hunter College, New York, New York, USA

Foster children making the transition from birth to foster homes or from foster homes to foster homes often present problematic behaviors. Limitations of attachment theory and reactive attachment disorder are presented, and three alternative approaches for understanding behaviors exhibited in foster settings are presented: conservation of resources, child alienation model, and developmental trauma disorder. KEYWORDS Foster care, COR, DTD alienation

INTRODUCTION Foster care is a confusing and transient (occasionally protracted) period in some children’s lives. History is replete with accounts of struggling families forced to abandon or indenture/apprentice their children to other families, rarely with any agency or government oversight (Hasci, 1995). Only in the last century was there a shift from informal arrangements for families’ Address correspondence to Barbara Rittner, School of Social Work, University at Buffalo, 685 Baldy Hall, Buffalo, NY 14260, USA. E-mail: [email protected] 363

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placing children to more structured fostering systems, with host families being compensated for providing care to children. Governments became increasingly involved as agencies grew larger and began depending on more than unpredictable charity sources for funding, especially once there was a concerted effort to provide children with home-based rather than institutional care. By the middle of the twentieth century, children were being proactively removed from parents and placed in out of home care if they were considered to be at risk (Fox & Berrick, 2007; Gil, 1984). Over time, federal laws began the shift in governing child welfare services from a local to a national system of care (Mitchell et al., 2005). What was once a system dedicated to removing at-risk children and placing them in alternative placements became a system vilified for allowing children to ‘‘age out of foster care,’’ creating a demand for new, more proactive services (Antler, 1978; Kerman, Barth, & Wildfire, 2004; Stein, 2000). Federal acts have been passed repeatedly to reduce the time children spend in care and to promote permanency planning. Rapid termination of parental rights and adoption were initially encouraged through subsidized adoptions (Adoption Assistance Child Welfare Act, 1980, P. L. 96-272), but by the mid1980s, concerns emerged about intact attachments to birth families leading to disrupted adoptions (Besharov, 1991; Hollingsworth, 2000). The 1984 Family Preservation and Support Services Act (P.L. 103-66) was expected to resolve continuing dispositional problems in child welfare by delivering enhanced services to birth families designed to prevent the need to bring children into care and to reduce the numbers of terminated parental rights and adoptions. By the 1990s, children were once again lingering in foster care and experiencing multiple caretakers over prolonged periods. In 1997, the Adoption and Safe Families Act (P.L. 98-02) was passed. This act purported to provide a more rational, though complex, approach to permanency planning by arguing for and enabling parallel planning for both return to birth families and termination of parental rights with subsequent adoption. The emphasis on expediting permanency decisions, including recognizing kinship care as a permanency option, was expected to reduce the number of children in foster care, increase the number of adoptions, and finalize permanent placements more expeditiously (Allen & Bissell, 2004; Festinger & Pratt, 2002). However, despite federal foster care policies, the system remains a complex amalgam of federal and state laws, state and local policies, procedures fraught with indigenous biases in interpretation of those laws, and implementation at local levels by direct service workers, judges, and foster parents, all within the context of community norms about acceptable parenting standards. The risks that bring children into foster care will not mitigate or ebb as a result of laws or policies. At last report, foster care was being provided to almost 500,000 children annually—with an average length of stay of 28 months in the system. More than 40% of the children in the foster care system were between 12 and 20 years of age, and more than 60,000 had been in the

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system for more than 5 years. The majority (54%) of children in foster care were returned to their birth parent(s). Many (18%) were adopted or lived with another relative (11%), and some were emancipated out of the system (9%). Among children in care for more than a year, only 51% had fewer than two substitute care placements in the first 2 years; and once children had been in the system for more than 2 years, replacement rates approached 75%. More than 5% of those age 12 and older were in group homes or residential placements (Administration for Children and Families, 2005). The stark reality is that most children in foster care are repeatedly on the move. They enter an impermanent system of care, awaiting either reunification with their birth families or placement in foster or adoptive homes. Because of the unpredictability of their situations, it is not surprising that over the years there has been considerable concern about the potential consequences of multiple placements (Barth, Crea, John, Thoburn & Quinton, 2005; Barth, Berry, Carson, Goodfield, & Feinberg, 1986; Grigsby, 1994; Mennen & O’Keefe, 2005; Penzerro & Lein, 1995; Pilowsky & Kates, 1996; Rittner, 1995; Stokes & Strothman, 1996; Stovall & Dozier, 1998; StovallMcClough & Dozier, 2004). In many cases, concern about the negative consequences of multiple placements has been framed in the context of attachment disorders. This study proposes reframing the issue of problems seen in placement of children into and within foster care and moving from a reliance on attachment theory to alternative approaches. It acknowledges the issues raised by Barth et al. (2005) regarding the utility of attachment theory within the myriad family relationships foster children experience precisely because it begs the question: attachment to whom? It suggests, instead, a more pragmatic approach to understanding the behaviors of children as they move through the foster care system, an approach grounded in emerging concepts about how children react and respond to complex traumatic events (Pynoos et al., 2008), how they become alienated from adult caretakers (Kelly & Johnston, 2001), how they manage transitions in the resources they have, and how they cope with losses of resources as a result of moves (Hobfoll, 2002).

FOSTER FAMILY RELATIONSHIPS Limitations of Attachment Theory in Child Welfare Attachment theory (Bowlby, 1982) has had a major presence in child welfare literature and training for decades. Elements of the theory were critical to making a strong case against casually moving children around within the foster care system without recognizing ongoing connections to birth or foster families. Further, it shaped many of the policies that governed the provision of preventative services to birth families before removing children and placing them in alternative settings (Aber, Allen, Carlson & Cicchetti,

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1989; Grisby, 1994; Hegar, 1988; Poulin, 1985; Proch & Tabor, 1987). Attachment schematics fueled training models heavily reliant on Ainsworth’s (1989) expansion of Bowlby’s work to explain children’s reactions to prolonged and unexpected separations from parents—a spectrum of attachment types from secure to disorganized/disoriented attachments (Lawrence, Carlson, & Egeland, 2006). Arguments to dismiss attachment theory as a foundation in child welfare, regardless of how it is measured, have been well articulated by Barth et al. (2005) and others (Dozier & Sepulveda, 2004), in part because attachment schematics do not adequately explain foster children’s behaviors when they confront losses of primary relationships and adjust to unfamiliar substitute caretakers. Clearly there are questions of timing when assessing attachment in foster children. In a matter of days, many of these children encounter serial parent substitutes—some of whom remove them from where they live, some of whom they may be related to and care for deeply, some of whom they do not know and may merely tolerate, and others whom they may find frightening. Children disrupted from one setting and placed in another often react in ways suggestive of attachment problems but which are more likely adjustment responses to new situations. Once children have been in a setting for a while, the responses observed in them are overshadowed by the specter of impermanence in their new relationships and conflicts and confusions about possibly staying where they are, leaving for somewhere else, or missing where they have previously been. Further, there is remarkably little empirical support for treating attachment in foster care, and most of what has been described is based on case studies (Barth et al., 2005). As Dozier and Sepulveda (2004) observed, foster children with histories of disrupted relationships, trauma, neglect, and developmental lags are moved into shelters and foster homes, and their behaviors are likely to reflect bewildering transitions in relationships rather than ‘‘attachment problems’’ per se. In essence, the question of which characteristics in foster families truly predict positive or negative outcomes and why is never fully addressed in much of the foster care literature on attachment (Orme & Buehler, 2001).

Reactive Attachment Disorder: Compounding the Problem Assumptions of disordered attachment in foster children have engendered the tendency to pathologize the process of adjustment to new settings with diagnoses such as reactive attachment disorder (RAD; American Psychiatric Association Diagnostic and Statistical Manual [4th ed. text revision], 2000). The etiology proposed for the disorder fits the profile of many children entering foster care: prolonged separations, traumatic experiences, and extreme poverty. Criterion A of RAD describes disturbed social relatedness beginning before age five—with significant problematic social interactions either along a restrictive or diffuse continuum as a key element of the disorder. It is


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worth noting that RAD is almost exclusively studied in children not residing with their birth families (Hall & Geher, 2003). Findings from studies such as Zeanah et al. (2004), which report evidence of both types of RAD in 40% of foster children, generally do not provide information on the length of placement with foster parents or the reciprocal level of attachment of the foster parents to the children being evaluated. Other studies, such as Leathers (2002), measured perceptions of belonging against behavioral disturbances in pre-adolescent and early adolescent children living in non-relative foster care and noted that stronger attachments to foster families appeared associated with lower behavioral problems and that difficulty forming strong relationships with foster parents appeared to predict higher replacements rates, especially for males. At the heart of the debate are concerns that the disorder lacks both differential diagnostic capability and discrete symptomology (Zilberstein, 2006). This is, in part, a product of the way the DSM-IV-TR (2000) frames the disorder: It focuses on behaviors that could derive from a variety of sources, including developmental delays (an exclusion), and blames the behaviors on pathogenic relationships within families. Many of the children in the child welfare system live in birth families with very few resources (Jones, 1998). These families cope with lack of income, unstable housing, and few family and friends who can provide ongoing assistance. Parents manage challenges inherent in long daily separations from their children and in living in dangerous and deteriorated neighborhoods that provoke legitimate fears for safety and may invoke appropriate ‘‘hypervigilance.’’ These parents rarely have time, energy, or resources to provide their children with much in the way of the intellectual and social stimuli necessary for optimal cognitive and social skills development. Ironically, the problem with excluding developmental delays in this diagnosis is that it ignores a documented consequence of severe poverty, neglect, and trauma exposure (Lieberman & Zeanah, 1995; Pynoos, Steinberg, & Piacentini, 1999; van der Kolk, 2007a, 2007b; Zeanah et al., 2004). Further, exposure to trauma and neglect occurs in foster and birth families, so the assumption that this is a consequence of parent-child relationships is seriously flawed. These children, in their short lives, experience a variety of competent and nurturing and incompetent, neglectful, and even dangerous caretakers, some of whom are related and others who are not. In turn, these children may evidence developmental lags in verbal skill acquisition, social skills, and indiscriminant attachment to adults as coping strategies in response to stress, symptoms considered central to the child characteristics of RAD (DSM-IV-TR, 2000; Ford, 2009). Parental characteristics associated with RAD include a lack of emotional availability and support and a failure of provision for physical needs. These characteristics are also associated with severe poverty, a condition foster children often experience prior to entering the system. That is not to dismiss lightly the long-term impact of such neglect on the development of children.

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It has been observed that high levels of neglect appear to predispose children to more psychological distress, physical and sexual abuse, and lifetime depression and dysfunction (Berrick, 1997), but these higher rates of distress are also associated with higher rates of poverty—even when parents are neither neglecting nor abusing their children (Bratter & Eschbach, 2005). Additionally, some have argued that the symptoms of RAD could just as easily be a manifestation of a child’s temperament or the result of other, more common disorders, including oppositional defiant disorder, conduct disorder (disinhibited), depression, social phobia (inhibited), and spectrum developmental disorders (both inhibited and disinhibited; Kaplan, Sadock, & Grebb, 1994). In fact, recently there have been challenges to the use of RAD with foster children and greater focus on the problems associated with attempting to assess or treat RAD, especially in foster care settings (Blatt, 2000; Marsenich, 2002). This includes Worrell’s (2000) concerns that there is little empirical evidence to support specific treatment for children with attachment disorders, a position strongly supported by O’Connor and Zeanah (2003a, 2003b). Finally, Barth and his colleagues (2005) suggest that more promising approaches in the child welfare system are those that enhance parent-child daily operational relationships—that is, those things that make day-to-day experiences less stressful and more productive.

Alternate Approaches It is useful for foster care investigators and workers, foster parents, guardians, and clinicians to understand the impact on children of extreme poverty, exposure to various types of abuse, and the process of entering into and moving through the foster care system. We propose three alternative approaches not commonly utilized in child welfare as a means of thinking about the experiences children have before, during, and after foster care: conservation of resources, child alienation model, and developmental trauma disorder. CONSERVATION

OF RESOURCES: A BETTER ECOLOGICAL FIT

In part, support for a move away from pathologizing of behaviors as disordered attachment is articulated by Nilsen (2003), who observed that children’s attachments are fundamentally adaptable and that a problem in one setting may not necessarily be a problem in another. As children enter any system of care, they experience many losses and may well manifest anxiety, depression, stressful interpersonal behaviors, withdrawal, externalizing behaviors, and moodiness as they adjust to new settings. Harden (2004) and Swick (2007) recommend that foster parents try to understand the histories and current circumstances of the children in their care through the lens of an ecological perspective, wherein all systems are considered relevant and influential.


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Conservation of resources (COR) theory is a useful framework to examine those factors at a global level that contribute to adjustment problems some children exhibit in foster care. It is a derivative of stress theory and ecological perspectives and was first hypothesized by Hobfoll (1986) to illuminate the interconnections among loss, threat of loss, or failure to gain resources and the consequent impact on abilities to adapt to and cope with stress (Hobfoll, 1988, 1989, 2002). Resources are defined as those things people value, and value is determined by the meaning attributed to the particular resource via shared cultural views (Hobfoll & Spielberger, 1992). COR posits that resources include (1) ‘‘objects (e.g., transportation, shelter), (2) conditions (e.g., tenure, seniority, a good marriage), (3) personal characteristics (e.g., social competence, self-esteem, sense of mastery), and (4) energies (e.g., money, credit, insurance’’; Hobfoll & Lilly, 1993, p. 129). As children enter into substitute care, they lose their environment (objects), their familial connections (conditions), their sense of who they are and what is expected of them as part of a given family (personal characteristics), and the comfort of daily patterns and most of their belongings (energies). In addition, many of these children come into care from ‘‘circumstances’’ marginalized by poverty and marked by unstable housing, community violence, fragmented social supports, and interpersonal connections and, as Hobfoll and Lilly observed, are, as a result, ‘‘less empowered [with] more vulnerable resources’’ (Hobfoll & Lilly, 1993, p. 129). COR provides a way to understand how children experience transitions into and through foster homes and why they may perceive that experience as involving the loss of most of the resources they have. It also helps to reveal the stark reality that foster children are generally powerless to produce their own resources and are largely dependent on the adults in the various social systems with which they interact to provide resources for them. As a result, they are likely to be very anxious and uncertain as to whether they can regain resources in new settings and whether the resources they are provided are the ones they need or want. It is axiomatic that having appropriate resources enhances capacities to adjust to stress and that inappropriate resources or a lack of resources increases vulnerabilities to increased stress reactions. Johnson, Palmieri, Jackson, and Hobfoll (2007) explored whether women with more resources, including psychosocial supports, were more resilient and whether such resources aid in recovering from posttraumatic stress disorder (PTSD; DSM-IVTR, 2000; see also Hobfoll, Johnson, Ennis, & Jackson, 2003). They reported that most of the women in their study lived in poverty, well more than half had histories of sexual assault, and many met criteria for PTSD, but those with relatively more resources were also more resilient and able to replace lost resources more quickly. Further, Schumm, Hobfoll, and Keogh (2004) found women with both physical and sexual abuse histories had higher rates of PTSD, interpersonal problems, revictimization, and interpersonal resource

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losses (e.g., ending of positive intimate relationships, unstable housing, job losses, and fragmented social relationships). These findings were further supported by findings of higher rates of depression and PTSD in a longitudinal study of low-income, inner-city women with multiple events of physical abuse (Schumm, Stines, Hobfoll, & Jackson, 2005). These studies are substantially applicable to foster care because of the parallels found in the lives of children in foster care: complex trauma histories, higher rates of severe poverty, marginal resources availability, and difficulty in replacing lost resources (Schumm et al., 2004, 2005). Finally, also according to COR, resource losses across multiple domains engender a greater probability that those resources will be less likely to be replaced, compelling increasingly primitive survival responses to additional stressors (Litz, Gray, Bryant, & Adler, 2002). From the perspective of foster children, their tendency to be reactive, self-protective, and defensive may reflect the primitive coping strategies observed in COR research, especially as they enter a system with very few resources and little expectation that even their most basic needs will be met. CHILD/PARENTAL

ALIENATION WITHIN FOSTER CARE

Also worth considering are parallels to an emerging field of inquiry into the negative behaviors and distress children display when their families are engaged in high conflict divorces (Gardner, 1992, 1998; Kelly & Johnston, 2001). Many of the factors associated with these divorces parallel factors children experience as they move through the foster care system. Though Gardner (1992) argues that hostility on the part of one parent toward the other with a child predisposed and encouraged to support the hostility leads to a syndrome of unreasonably biased, disordered, and even pathological relationships toward a non-custodial parent (parental alienation syndrome as he labels it), Kelly and Johnston (2001) argue that there is little empirical support for parental alienation as a syndrome (Gardner, 1992). Instead, they suggest that most children going through high-conflict divorces fall along a complex continuum of child-parent relationships in which children may remain connected to or become alienated from parents for a variety of legitimate and concern provoking reasons. Using the Kelly and Johnston (2001) model offers some utility in understanding how children leave the care of biological parents, enter into relationships with caretaking adults in the foster care system, and either form alliances with caretakers or feel estranged from them. Entry into the foster care system, viewed from a child’s perspective, may share features with high conflict divorces in the potential for acrimony among the various parties: biological family members, clinicians, foster parents, attorneys for the state or the parents or the children’s guardians ad litem, child welfare workers, and other children residing in foster homes. Children in foster homes may


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be encouraged to or spontaneously may speak angrily about birth parents, including expressions of hostility and rage for their perceived abandonment. They may be informed, infer, or declare that their parents never cared for them or constantly placed them at risk—allegations that may or may not be true. Worse, like children in high-conflict divorce proceedings, they may find an audience that is more than willing to encourage and believe that the negative feelings toward their birth parents are justified and legitimate, provide intended or unintended positive feedback to them for expressing negative feelings, and reject supportive and sympathetic statements proffered by them about birth parents as misplaced loyalties. Children, in turn, may feel under pressure to report and expand on details of their experiences in their families or enhance details at granular levels because various adults— foster parents, foster care investigators, foster care workers, judges, attorneys, mental health practitioners, and so on—repeatedly ask them to provide particulars of the circumstances that led to placement and specifics about each experience with biological parents during visitations. They may also perceive that acquiescing to pressure to report on birth families will help them garner needed resources, despite birth parents instructing their children that disclosures of any details of their visits or their home life constitute disloyalty. Children may be physically inspected after visits for evidence of physical abuse and repeatedly questioned about the smallest details of visits. Dysregulated behaviors may be interpreted as evidence of their rejections of/by their birth parents, and the distress that they experience subsequent to separating from parents may be considered evidence of ongoing maltreatment. Birth parents may inspect children closely, looking for signs of maltreatment, question them about their experiences in substitute care, encourage negative reports about their experiences with foster families, or may insist that foster parents do not really care about them or are ‘‘in it or the money.’’ Children may feel pressured to falsely report maltreatment or may be reluctant to report actual maltreatment for fear of retaliation by birth parents, foster parents, foster siblings, and the various other adults in the system. It is understandable that children, especially children who feel ambivalence toward their birth parents, may begin to resist visitations. The interpretations of such resistance may be framed within the context of RAD or attachment problems, when it may, in fact, reflect their attempts to accommodate an impossible situation or may be manifestations of their coping strategies in the face of high stress and traumatic experiences. Taken in the context of child alienation, many negative behaviors may well derive from system dynamics of all the stakeholders as children move through a complex system with conflicted and confused loyalties. As a step toward correcting the effects of alienation, commitments by foster parents to provide optimal environments (within the limits of their capabilities and resources) for the children in their care may well play a role in successful

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placements (Brown & Campbell, 2007; Buehler, Cox, & Cuddeback, 2003; Dozier, 2005; Dozier & Lindhiem, 2006; Harden, Meisch, Vick, & PandohieJohnson, 2008; Hurl & Tucker, 1993). If child alienation is considered as a component of foster children’s experiences, it is imperative that caseworkers begin to consider the actual impact of traumatic events on these children. DEVELOPMENTAL

TRAUMA DISORDER: UNDERSTANDING

TRAUMA IN CHILDREN

In most cases, everything about coming into foster care is traumatic (Simmel, Barth, & Brooks, 2006), and many of the children entering the system have experienced complex trauma. There is no question that being removed from parents and placed in shelters and/or foster homes is stressful to children regardless of how dysfunctional or dangerous their biological families are. Many of these families have prior encounters with the system, and the specter of ‘‘removal’’ associated with both investigations and supervision increases the stress on these families and compounds it when it actually happens (English, 1991). As van der Kolk (2007b) and Pynoos et al. (1999) argue, what is experienced as traumatic to a child may not even concern an adult or may generate only minimal distress. For example, being unintentionally separated in a mall for 30 minutes is distressing to adults but is terrifying to toddlers. The impact of trauma on the development of the brain and emotional regulatory system in children is not fully understood, but trauma exposure in childhood, including severe neglect, seems to be associated with pervasive and longrange problems in the ways that children view themselves and their world and in their ability to cope and respond appropriately to stressors (van der Kolk, 2007a, 2007b). Developmental trauma disorder (DTD) is a proposed diagnostic category to describe how complex trauma events force children to shift into survival mode in response to increased victimization, creating reactive behaviors and dysregulated interpersonal relationships (Ford, 2009). Foster children come into care with histories of exposure to multiple stressors. These stressors vary from minor to extreme severity and from single to multiple events. In many cases, children may be emotionally or physically harmed in their households and neighborhoods; they may experience single or multiple physical or sexual assaults; and they may witness violence being perpetrated toward others, including those in their families or in their communities. There are debates about the degree to which exposure to violence in their homes directly harms them, and the reality is that some children are more resilient than others (Margolin & Vickerman, 2007). Not all incidents of abuse and neglect result in child protective services (CPS) investigations because many are unreported or because there are other moderating factors (a parent flees with the children from an abusive relationship, for example). Further, though many CPS investigations result in supportive resources being provided that help to secure and protect families, investigations may also


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rupture families by separating children from parents and scattering siblings. Long before CPS becomes involved, children who eventually enter the foster care system often experience the duress of unpredictable behaviors exhibited by caretakers with mental health and/or substance related problems, often co-occurring with violence in their homes and neighborhoods that places them either at additional risk or in harm’s way. It is not surprising that in recent years, children in foster care are likely to be assessed for PTSD; a diagnosis of PTSD may well be warranted. Conversely, children who are chronically neglected, ignored, or live in extreme poverty that marginalizes their families in substandard and often dangerous housing and forces them into frequent moves or periods of homelessness or those who are psychologically abused by family members and bullied by community members may be just as adversely affected by their situations but may not meet criteria for PTSD. An important question is, should they? In recent years, many of those evaluating the impact on children of adverse childhood events have begun to consider the impact of those events on neurophysiological and cognitive development and on subsequent social functioning (Briere & Spinazzola, 2009; Ford, 2009). There is strong evidence that infants and young children exposed to violence, severe neglect, and emotional abuse are likely to lag in neurocognitive development, identity integration, emotional regulation, and the ability to form relationships (Ford; Simmeon et al., 2001). Basel van der Kolk’s (2005) longitudinal retrospective study of 17,337 adults suggests that childhood trauma histories of physical and sexual abuse were highly correlated with increased episodes of mood and anxiety disorders, significantly higher rates of risk behaviors such as poly-substance use, suicide attempts, multiple sexual partners beginning in early adolescence, and domestic violence as both victims and perpetrators (see also Pynoos et al., 2006). His findings are consistent with those described by Stalker, Palmer, Wright, and Gebotys (2005) that enduring trauma symptoms are associated with depersonalization and dissociation, multiple hospitalizations, and difficult interpersonal relationships in a sample of inpatients with severe childhood trauma histories. At the National Center for Child Traumatic Stress, co-directed by Robert Pynoos and his researchers (see Pynoos et al., 2008, 1999), longitudinal data are being evaluated to determine the types of traumas children experienced, when they experienced it, the duration of the trauma, and the long-term impact of the trauma on their development and functioning. They and others (see Ford, 2009; van der Kolk, 2005) have proposed that exposure to complex trauma in infancy and early childhood causes sufficient developmental problems to support its more properly being described as DTD. DTD is a more age-sensitive symptom profile of the nature and sequelae of both interpersonal and mass trauma on young children and toddlers that yields ways to assess and treat those children in comprehensive rather than piecemeal approaches (Pfefferbaum et al., 2006; Pynoos et al., 1999, 2006;

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van der Kolk, 2007a, 2007b). Among the important themes emerging in DTD research is the understanding that complex childhood trauma alters normative developmental processes across many domains and appears to have a deleterious impact on cognitive, adaptive, social, and emotional growth and on altered memory structures. It is not surprising that children in the foster care system fit the DTD profile as the very experiences that bring them into the system are those studied in DTD research. Under the rubric of DTD, complex trauma exposure leads to the creation of alternative mechanisms for responding to the environment. Exposure can result in the brains of young children shifting from a learning/experiencing mode to one of primitive survival. As Ford reports, ‘‘: : : the survival brain is fixated on automatic, nonconscious scanning for and escapes from threats’’ (p. 35). Transitioning from birth to foster home or foster home to foster home is likely to be perceived as threatening. Ford and others (Pynoos et al., 1999, 2008; van der Kolk, 2007a) make a case for DTD as more relevant than attachment in understanding why children in the foster care system are often so highly unpredictable and aggressive and, in particular, why they tend to respond in protective, dysregulated, and reactive ways to unfamiliar stimuli. Recent studies strongly suggest that beginning in early infancy, children are assembling comprehensive schemata of themselves, their caretakers, and their worlds, all of which shift as new information and skills are acquired and others are pruned and discarded as needs for them extinguish (Parvizi & Damasio, 2001). New findings suggest that children as young as 6 months show evidence of extremely good memory/perceptual processing, including for faces (Nelson, 1993; Pascalis, de Haan, & Nelson, 2002), but the kinds of severe trauma events that result in children’s being placed in foster care tend to distort how memory is stored and retrieved, resulting in attention, learning, and verbal processing deficits, especially in infants and toddlers (Ford, 2009). It is not surprising, therefore, that many children in the foster care system are unable to articulate their experiences in meaningful or helpful ways to workers or clinicians or to develop self-reflection as a means of regulating reactive responses, especially to perceived threats. If this is the case, it helps to explain why so many children in the foster care system appear to have few (sometimes none) or very inaccurate memories of the adverse experiences that brought them into care or occurred while in care. Rovee-Collier (1997) observed that adults and children store memories of significant events mutually in the hippocampus (explicit memory) and in the amygdale (implicit and more emotional/visceral memory) and that severe trauma seems to disconnect these two areas of memory processing, suggesting why young children more often retain implicit than explicit memories that drive survival behaviors and why they are more likely to experience emotional dysregulation and self-harming behaviors when confronted with triggers for those memories (Rovee-Collier; van der Kolk, 2007). This may also help to explain why some foster children seem to have extreme reactions


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to apparently neutral stimuli, such as the one described in a case study presented by Kaplow et al. (2006). They describe the impact on a 19-month old girl of her father’s murder of her mother by gunshot while she was in her mother’s arms. The girl’s subsequent ‘‘irrational’’ fear of a red coat worn by her grandmother was apparently associated with her mother’s blood. Viewing extreme stress reactions from a developmental perspective (DTD) facilitates understanding how certain exposures may not only be traumatic but may, in turn, influence children’s adjustment to substitute care, their ability to form relationships with caretakers, and their seemingly ageinappropriate dysregulation under stress. DTD presents ways to understand why children who come into foster homes with significant traumatic experiences often have multifaceted long-term sequelae that include developmental milestone lags, depression and dissociative disorders, significant social deficits, higher levels of internalizing and externalizing behaviors, and patterns of destructive and aggressive behaviors (Mongillo, Briggs-Gowan, Ford, & Carter, 2009; Scheeringa, Zaneah, Myers, & Putnam, 2003; Saltzman, Pynoos, Layne, Steinberg, & Aisenberg, 2001). Rather than perceiving the problem from the narrow lens of attachment and RAD, DTD offers a broader understanding of the multiple-cognitive and social domain impact of these events on children as they move through the foster care system and provides multiple, potential avenues of intervention to directly address and treat complex trauma experiences (see Kaplow et al., 2006).

CONCLUSION Barth and his colleagues make a powerful case for greater reliance on evidence-based approaches in child welfare and repudiate excessive reliance on attachment theory and related constructs (Barth et al., 2005). However, it is difficult to develop strategies to promote optimal functioning in the absence of ways to understand what might drive problematic behaviors as children move through foster care systems. Understanding behavior in the context of trauma, recognizing the tensions that exist among the people in these children’s lives, and acknowledging the sense of loss of resources and difficulty in replacing those resources these children experience provide a more complex way of understanding behaviors evidenced in foster care as children adjust to new surroundings and unfamiliar caretakers. Beginning at a systems level, it is imperative to recognize that many children enter foster care with experiences of diminished and depleted resources associated with poverty and that these children have little likelihood of replacing lost resources as they move from one place to the next. COR provides a framework for understanding why these children often hoard or gobble food when they can (Geiser & Malinowski, 1978), become extremely upset when they are separated from their few belongings, and why providing

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them with familiar foods, hygiene products (including soaps and laundry products), and access to siblings and family members is so vitally important. Shifting their perspective from pathologizing the behaviors to recognizing experiences of loss will allow foster parents and child welfare workers to identify means to build an infrastructure tailored to an individual child’s particular history and will provide that child with the resources needed to accommodate current circumstances. Such approaches may include ensuring that transitional objects (familiar blankets, toys, cups, and the like) accompany children into their new environments and identifying ways to make integration of those items acceptable to foster parents. Because it is not uncommon for foster parents to reject the introduction of items into their homes perceived as filthy or contaminated, this approach may require helping foster parents understand why replacing those items may not adequately meet the children’s needs. Likewise, ensuring that children have access to siblings and other important people in their lives who predate placement provides a sense of what Nelson (1993) referred to as autobiographical memory, part of what Hobfoll and Lilly (1993) consider personal characteristic resources. Finally, activities to help children develop a sense of continuity of self are critically important, especially for older children. Playing in sports leagues or visiting with or talking to friends from their prior communities are ways to regain ‘‘energies’’ as they settle into their new settings. It may prove difficult to prevent the adversarial relationships that can occur when children are in the foster care system. However, delimiting the direct exposure of children to the conflicts and avoiding mechanisms that triangulate children unnecessarily are imperative. Efforts must be made to provide training to case workers and court personnel to delimit their contribution to the alienation of children from their caretakers (birth and foster). Recognizing that children in foster care are required to respond to multiple situations involving conflicted loyalties is crucial, especially when they are pressured into reporting the actions of neglect or abuse at the hands of their birth parents or in their foster homes. Child alienation provides a lens with which to understand why children are tentative when being integrated into new and unfamiliar families because it addresses the ongoing conflictual dynamics which often in force. Finally, clinicians working with these children would benefit from understanding how complex trauma has shaped the children’s lives and the complex ways in which they respond to their environments. Trauma assessments must be sensitive to developmental issues and the impact of severe trauma histories. Shifting assessments from the adult models inherent in PTSD to the more age-appropriate insights available from DTD will allow interventions to address the neurocognitive, social, emotional dysregulation, and functional lags evidenced in so many of the children in foster care. All of these approaches provide mechanisms to help these children become more adaptive to their environments.


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