Dr. Mary Wingo has studied the stress impacts on the human brain. She shares with our Fostering Families Today readers how children in foster care are impacted by that stress more severely than many other populations and why foster parents and caseworkers can lessen the severity of PTSD.
1. What is PTSD and what’s its prevalence in children in foster care? PTSD (along with nightmares and emotional flashbacks) occurs when a person is exposed to stress that is beyond her carrying capacity to process and resolve. When there is exposure to multiple traumas, there is a high risk of developing Complex PTSD. Most children in foster care have traumatic life experiences that result in an increased risk for mental health disorders. A study of children in foster care revealed that post-traumatic stress disorder, or PTSD, was diagnosed in 60 percent of sexually abused children and in 42 percent of the physically abused children. The study also found that 18 percent of foster children who had not experienced either type of abuse had PTSD, possibly because of exposure to generalized domestic instability, according to the U.S. National Library of Medicine National Institutes of Health’s report “Mental Health Services for Children Placed in Foster Care: An Overview of Current Challenges” and “Sexually and physically abused foster care children and post-traumatic stress disorder.” Furthermore, more than 60 percent have some type of lifetime mental illness diagnosis.2. Why is this population so likely to experience PTSD? We must keep in mind that the human stress response is simply made up of our collective adaptive responses. These responses serve to help us adapt to changes and demands in the environment. In fact, my contemporary definition of stress is the rate of biological adjustment needed to adapt to whatever demands the environment throws at us. Keeping this in mind, our primary stress-response organ — the frontal lobes, do not reach full maturity until about the age of 25. The frontal lobes allow us to project creative solutions into the future, and then allow us to follow up with these plans in an organized fashion. They permit us to inhibit impulse and emotionally regulate in order to reach near or distant goals. The frontal lobes have allowed us to dominate the animal kingdom, and have bestowed a definite type of evolutionary fitness. We would not have evolved the sophisticated societies and technology we have today without the presence and functioning of our frontal lobes. This being said, the frontal lobes are quirky and prone to malfunctioning during high and continuous stressful situations. In lower stress situations, the frontal lobes help us adapt and attenuate stress. In high stress situations that last a long time, the body shuts down rational thought in order to conserve vital energy. Brains that have not reached maturation are especially vulnerable to stress. This is why as adults we instinctively want to protect children from exposure to extreme stress. Extreme stress causes stress-related brain and other biological injury, much of which has lifelong consequences. 3. We’ve read that kids in foster care have a higher rate of PTSD than do war veterans…is this true and why? Yes, they do. This is because the trauma experienced by most war veterans occurs when the frontal lobes are at maturity or near maturity and adults have a more mature stress-response mechanism. 4. For children with PTSD, what is the best treatment plan? Oxytocin, a highly conserved and ancient hormone is released during times of person-to-person bonding. Many traumatized children have had limited opportunities to bond with a caregiver. Oxytocin dampens the fight-or-flight response to flashbacks, thus allowing a relief to debilitating symptoms. While it is tempting to speculate about administering oxytocin in drug therapy, the best way to stimulate natural oxytocin is to allow the child to form a narrative (or story) about her experiences in a super-safe and supportive environment. The super-safe environment allows the child to trust, which is the result of increased oxytocin release. The narrative allows the child to repair damaged memory systems of the hippocampus, thus relieving debilitating flashbacks. For a lot of children, you may have to approach this carefully, but touch is a big component in helping to increase oxytocin levels and build connection. When we’re first born, our mother is constantly touching us, so if a child is able to tolerate positive touch that’s key. With traumatized children, an environment of yelling and raising your voice — anything that causes the flight or fight reaction to occur is challenging. Alternately, anything that causes a child to relax and feel more bonded will help their brain heal from early trauma. It’s important to cultivate a sense of safety in the child. Over time, the result of this allows the child to think about previous traumatic events without going into flight and fight mode. Simple things like a regular daily routine that includes quality time building bonds and creating a sense of safety demonstrate stability and signal from the parents that they’re in a safe, stable environment. 5. How does treating children with PTSD differ from treatment for adults? Many children with PTSD have never properly bonded with a caregiver, so they form attachment problems due to oxytocin never being released properly and consistently. Cultivating feelings of super-safety is a must. 6. For foster parents, kinship parents, adoptive parents and other caregivers, what can they do to address the unique needs of these children with PTSD? Cultivate a safe environment that hopefully permits bonding and narrative disclosure.
7. What is so critical for these families to understand about PTSD? PTSD and Complex PTSD involve disruptions to memory centers and other organ systems. These families must understand what stress really is (that is, the types of common stressors in modernized societies) and mitigate preventable causes as soon as possible. Stressors are cumulative, and the more stress a developing body is exposed to, the greater the odds for further traumatization.8. For children with PTSD, is this a lifelong disorder they will have to navigate? Yes, please direct your readers to the Adverse Childhood Experiences Study here for additional information.Without intervention, many of these children will live significantly shorter lives, up to 20 years less. On the other hand, there is opportunity for post-traumatic growth as well. 9. What resources are available on PTSD that would help foster parents, kinship parents, adoptive parents and other caregivers? Pete Walker is a valuable resource for understanding and confronting childhood trauma. You can find more information at http://pete-walker.com. Many of your readers will gain valuable resources from my website at www.marywingo.com or from my book, which is a low cost, humanitarian project that can be found at http://amzn.to/2g8EiLv. Bessel Van der Kolk is a renowned physician and researcher in Complex PTSD and has many videos and free resources. You can find more information on his website at http://besselvanderkolk.net/index.html.