Children in Foster Care & Mental Health Disorders

By John DeGarmo, Ed.D.

Anxiety in children experiencing a disruption can manifest in a number of ways, perhaps none more frequently than separation anxiety, excessive concern over separation from home, family, and from those to whom they are most attached. Although children enter foster care through no fault of their own, they often suffer from mental health issues, some undiagnosed or caused by the initial separation from their first family. 

Any subsequent disruptions can be so severe, the child may feel as if their entire world is falling apart. And for them, it is because everything they know to be true in their world is turned upside down. The home they lived in is different and the family they made memories with is no longer there to care for them. And, for far too many children in foster care, the school they attended, their teachers, and their friends have all been replaced. These seismic shifts, in reality, leave children struggling to survive as they adjust to a new home and family.

Anxiety Disorders

The more often a child moves, the greater the concern becomes. Children who undergo numerous displacements often erect emotional walls to protect themselves and keep others out, hoping to minimize the anxiety they’re experiencing. In attempting to ameliorate their pain, the child may lie to their foster family as they try to create emotional distance and at the same time have a sense of personal control. 

Other anxiety disorders include obsessive-compulsive disorder, that is, repeated unwanted thoughts, actions and/or behavior out of a feeling of need. Panic disorders leave children experiencing intense bouts of fear for reasons that may not be apparent to an outsider. These attacks can be sudden and unexpected, as well as repetitive in nature. Panic disorders can also coincide with strong physical symptoms, such as shortness of breath, dizziness, increased heart rate, or chest pains. Another anxiety disorder children in foster care may experience include social phobias, or the fear of being embarrassed or facing criticism from others.

Depressive Disorders

The loss of a family may cause a child in care to spiral into depression, which may intrude into all areas of a child’s life, limiting their ability to function at home, in school, and in their interactions with peers. Children who suffer from a depressive disorder may exhibit strong and continuous sadness and may have difficulty focusing on school work or daily life, concentrating instead on death or having suicidal ideations. Loss of appetite or severe changes in eating habits may also be symptomatic of a depressive disorder. Additionally, feelings of guilt over the placement may also be overwhelming to a child in care. Finally, a child who suffers from a depressive disorder may lack energy in day-to-day tasks, or have difficulty falling or staying asleep.


Dealing with separation and loss is difficult for anybody. Children, especially those in care, generally do not know how to handle these feelings and emotions. Nor are children provided the tools to process their thoughts and feelings. Yet these feelings must be released in some fashion. One way children express feelings of isolation is by lashing out in anger and frustration at those around them. Though children in foster care do not necessarily blame the foster parent or the caseworker, their frustration and loss are keenly felt, and the resource parent or the caseworker may bear the brunt of the child’s emotions. As the child lashes out, anger may also result in the destruction of property or items within the foster home. 

Mental Health

For a child in foster care, frequent moves increase the likelihood the child will be at greater risk for future mental health crises. The longer a child stays within the same foster family home, there’s increased opportunity for emotional bonding creating a sense of stability, which benefits social behavior, academic performance, interactions within the community, as well as interactions within the foster home.

Finally, there are those times when mental health illness and mental health issues go undiagnosed and unrecognized. This might simply be due to the fact that, on the surface, the child appears to be fine and in good mental health.   Mental health issues can still exist, even for those children who often smile, laugh considerably, performs well in sports and other extracurricular activities, overachieves academically, and appears to be well-adjusted, so to speak. Yet, these might be the children who suffer the most from mental health.

Many of the mental health issues foster children face may never be addressed. Further, the psychological and emotional challenges they face may worsen and increase, rather than improve and decrease. That’s because in many cases, these children will not receive adequate mental health or developmental services, due to a lack of government funding and lack of resources, as well as understaffed and overworked caseworkers. 

John DeGarmo, Ed.D., is a TEDx speaker and an international expert in foster care and parenting. DeGarmo and his family have had more than 60 children who have come through their home. He is a consultant to legal firms and foster care agencies, as well as a speaker and trainer on many topics about the foster care system. He is the author of several foster care books, including “The Foster Care Survival Guide,” and writes for several publications. DeGarmo has appeared on Good Morning America, COURT TV, CNN, ABC, CBS, NBC, FOX, PBS, Good Housekeeping, and others. He can be contacted at [email protected], through his Facebook page, Dr. John DeGarmo Foster Care Institute, or online at The Foster Care Institute.



Engler AD, Sarpong KO, Van Horne BS, Greeley CS, Keefe RJ. A systematic review of mental health disorders of children in foster care. Trauma, Violence, & Abuse. 2022;23(1):255-264.