How PTSD Impacts Outcomes for Foster and Adopted Children

How PTSD in Foster Children Impacts Long-Term Outcomes

How Does PTSD Impact Your Foster Child's Life?

What every foster and adoptive parent needs to know about traumatic experiences and youth in foster care.

The foster care system is full of children and adolescents who make up a tapestry of trauma and resilience. Each child's story of loss, neglect, or abuse is dynamic and unique. Yet each shares the foster care experience. They also share an awareness that the "outside world" has come in and taken them from parents unfit, unwilling, or unable to care for them.

Within the separation itself comes strangers with unknown intentions in an unfamiliar environment. Even though foster homes and foster care programs aim to protect children and offer loving care, no child wants to be there.

Foster children often do not get a chance to say goodbye to siblings or the parents who could not keep them safe. Many children face physical or emotional abuse from their biological parents. The situation may become more complex when they first enter the child welfare system. Loss and anxiety during this transition may compound their original trauma.

Even the shortest stays in foster care can produce overwhelming fear and expose deep vulnerabilities that come with it. For children taken from their familiar homes, routines, and families, the trauma of separation can be lasting. As kids grow into adulthood, certain events or feelings that remind them of their past can trigger difficult emotions.

When a foster youth cannot live in their birth home and no other family can care for them, they enter the foster system. Their new foster family will provide care for them. A significant number of foster kids will receive a diagnosis of some form of emotional trauma. The most severe among them will suffer from Post-traumatic Stress Disorder (PTSD).

The Virginia Department of Social Services (VDSS) reports close to 5,000 children are in Virginia foster care. Around 5% are infants and an additional 20% are just 1-5 years old. 25% of children in Virginia foster care are young school-age and pre-teen kids 6-12 years old.

The remaining population is teenagers. Around 30% are transitioning into high school or independent life as a young adult. The luckiest foster kids will find what the industry calls "permanency." Many foster youth would just call it home.

For aspiring foster-to-adopt parents, these vulnerable youth may heal and thrive as part of your forever family. Every day, thousands of new adoptive parents provide nurturing care and show adopted foster children it's safe to trust. Adoptive families give children a sense of belonging and stability where they can flourish.

What Every Adoptive Parent Needs to Know about PTSD

Post-Traumatic Stress Disorder (PTSD) in Young Children 

PTSD may develop in some people following a stunning, shocking, or scary event or experience. Often PTSD follows a person's natural trigger of our "fight or flight" response from the perceived danger. This reaction can be short-term, such as an episode of violence. It can also prolong over time, such as in ongoing cases of abuse, neglect, or disaster.

Similarly to all forms of trauma, perception influences a person's PTSD. For example, a child may go through a traumatic event. However, they might not feel traumatized if they sense their caregiver and others around them aren't in distress.

By contrast, children, especially those under the age of seven, experience PTSD differently from adults. Younger children may not be able to articulate their trauma. This inability to give words to what they are processing puts kids at risk of adverse impacts on their developing brains.

Early childhood trauma may interfere with healthy development of the brain cortex. This area of the brain plays a role in memory, language, and our ability to regulate emotions. Complex responses to trauma can lead to impaired functioning, which experts have reported in preschool children.

Our youngest children may also develop other mental or emotional problems resulting from trauma. Among the most common are Separation Anxiety Disorder (SAD) and Oppositional Defiant Disorder (ODD). These and other complex forms of PTSD may take a long time to heal depending on the circumstances of the trauma.

Consider the family crisis or abuse that led to a child's removal from their birth family. The separation from home and family is another impact. Unique factors also include a child's developmental stage, level of exposure, and perception. Once children are physically safe, each has their own starting point from which they can start a healing process.

A child's developmental stage plays a role in their initial and long-term response to PTSD. As we will review, it also affects effective PTSD treatment options.

Causes of Early Childhood PTSD

Child Protective Services receives three million reports of child abuse every year. These cases involve 5.5 million children. Experts estimate that about two-thirds of child abuse cases go unreported. However, around 30% of reported cases have enough evidence of abuse for authorities to intervene.

The approximate breakdown by type of abuse case includes: 

  • 65% Neglect
  • 18% Physical Abuse
  • 10% Sexual Abuse
  • 7% Emotional Abuse

Few humans escape experiencing trauma during their lives. Studies from the U.S. Department of Veterans Affairs show that 43% experience trauma. A smaller portion, 3-5% of girls and 1-6% of boys. develop PTSD.

Developmental Trauma Disorder (DTD) usually refers to pre-verbal children. Typically, it stems from a familiar person as a long-term abuser. The abuse may involve prolonged or repeated trauma. 

Child Abuse

The Department of Child Services (DCS) investigates many cases of suspected child abuse or neglect. There are four primary categories of child abuse: 

  • Neglect - Failure to provide basic needs for a child, including clothing, food, medical attention, or education. Over half of foster care cases result from this form of child abuse.
  • Physical abuse - Action that causes physical harm, such as hitting, burning, or choking.
  • Emotional Abuse - Excessive criticism, rejection, or isolation that impacts emotional health and well-being.
  • Sexual abuse - Harmful actions of a sexual nature, such as rape, incest, molestation, or exposure.

While accurate resources are difficult to find, authorities estimate over 2,000 children die from maltreatment every year. 

Domestic Violence

NCBI studies indicate that about 10% of kids are exposed to domestic violence each year. Broadly defined, this may involve any form of abuse or extreme violence, such as murder. 

Deaths or Traumatic Events

PTSD can be triggered by a traumatic family or community event. Mass gun violence is frequently in the news, and even primary schools across the country practice active shooter drills.

Trauma can also be caused by natural disasters, such as fires, tornadoes, or hurricanes. An example is the historic flooding and destruction caused across multiple states by Hurricane Helene in September 2024. Researchers can measure impact only in hindsight, such as for Hurricane Katrina victims. One study of New Orleans school children who experienced Hurricane Katrina found that over 60% developed symptoms of PTSD. 

Other traumatic events that can cause PTSD include:

  • Severe injury or death of a familiar person
  • Single violent events involving fire, car wrecks, or public shootings 
  • Suicide of a familiar person
  • First-hand witnessing of community-based violence 

It is worth repeating, perception is reality. How a child perceives the violence or trauma they encounter plays a role in their risk for developing PTSD. Risk contributors include a combination of factors, including whether the traumatized child is a witness or a victim. Other examples include the child's developmental age, parent and support system response, and the severity of the traumatic event. 

Foster Care Separation and Trauma

Many children in foster care face trauma. This trauma arises from the events that caused their separation and from their removal.

Many foster children describe this time as chaotic, with their whole worlds turning upside down. One young child described the fear as similar to what a small animal feels when running from a predator. Older kids can often express their feelings of anger, loss, and fear. Foster youth commonly feel out of control and fear the unknown.

For children of every age, moving into a strange place, often without siblings, belongings or goodbyes, is scary. Add foster families and social workers to the equation, and the trauma comes into sharper and unyielding focus. Even for those facing abuse at home, there is some comfort in familiar people, favorite things, and routine.

In cruel contrast, caring foster and adoption advocates aim to provide a soft landing place for kids entering care. However, even in a physically safe environment, the feeling of comfort and healing requires stability and time.

Without routines and familiar spaces, children often feel unsafe or out of control. They feel affected but remain disconnected from the decisions that impact their lives. 

Child protection officials often remove children to keep them safe. This usually happens when the children are outside their homes, at school, or during appointments. Without the chance to prepare, pack, or say goodbye to their parents and siblings, children feel stress and loss. They also experience fear and anger without getting closure. 

The trauma of separation after abuse and neglect often makes kids feel unworthy of love. They may also feel that they cannot trust any adults. Common responses are to withdraw or build protective barriers to push others away.

Without realizing it, traumatized children often behave in ways that prolong their suffering and isolation. Following a loss of innocence at the hands of people meant to protect them, children need consistent patience and care from safe adults. 

Signs of PTSD in Young Children 

Infant responses are attuned to the emotions of the parent or caregiver. Babies who sense distress in some form may react in several different ways. For example, if a baby senses fearful anxiety or intense anger, the baby could become fussy or withdrawn. Babies in this state may be hard to soothe and may have irregular eating and sleeping patterns. 

Preschool-aged children from 2-5 years are responsive to parent and caregiver nurturing. For kids with PTSD, scary memories and persistent, unwanted thoughts can make them feel like they are in danger. PTSD behaviors in toddler and preschool ages include the presence of or increasing:

  • "Playing" the event or repetitively talking about a traumatic event
  • Irritable outbursts or tantrums
  • Excessive upset in the forms of tearfulness and crying
  • Fear of being left alone, the dark, or monsters
  • Noise or sound sensitivity 
  • Disruptions to patterns of sleeping, eating, and going to the bathroom
  • Separation anxiety and clinginess
  • Reversion to earlier behaviors like thumb-sucking, bed-wetting, or using baby talk

Treating PTSD in Children

Mental health professionals and researchers continue to learn more effective ways to treat infants and young children with PTSD. As we learn about child development, professionals improve their skills in creating care plans for kids with PTSD. Contemporary effective approaches include:

  • Play Therapy - Helps children express emotions and process their trauma through creative activities and age-appropriate play 
  • Trauma-focused Cognitive Behavioral Therapy (CBT) - Helps children identify and cope with upsetting beliefs and distorted perceptions and fears
  • Eye Movement Desensitization and Reprocessing (EMDR) - Focuses a child's attention on sound or movement to diffuse the traumatic memory association during recall   
  • Long-term Relation-based Therapy - Processes deep-rooted feelings to help a child manage feelings about specific relationships involved in their trauma

For foster and foster-to-adopt families, it's vital to have the whole family involved in treatment therapies. PTSD impacts not only the traumatized child but how they relate to every other person. One benefit for foster children who have found a permanent home is that they belong to a loving family. An adoptive family can nurture, support, and strengthen bonds as a family for their lifetime. 

How Foster-to-Adopt Parents can Provide Trauma Foster Care

So, how can foster and adoptive parents help children with PTSD? While every developmental age and child trauma is unique, there are guiding principles to follow.

For infants, everyone nearby must stay calm and speak softly, especially when caregivers provide direct care for the baby. Primary caregivers must meet the baby's needs to bond. This helps the baby learn to trust and form a healthy attachment. Bonding behaviors include smiling, making eye contact, talking, holding, and making physical contact to comfort the baby.

Be Patient

Patience is a fundamental attribute for all parents and especially foster and adoptive parents. The system frequently moves older foster children multiple times. Keeping open and supportive communication allows them to feel safe when they want to share their experiences and feelings. Pressing them may cause them to withdraw or shut down.

Allowing children to talk on their own timeline is critical. Be prepared to answer questions they may have; sometimes repetitively. Other family members can help by sharing their feelings. Each can join family discussions about natural feelings like fear, anger, or sadness.

When you welcome a foster child into your home, give time and space for your child to grow comfortable. As you notice this happening, give them small tasks. This will help them feel like valued members of your family. Take it slow and easy to ensure your child doesn't feel stress with new roles and responsibilities.

As you show patience, look for meaningful ways to offer comfort and support for your child. Parents often naturally want to hug or cuddle with their kids as a way to show affection and make kids feel safe. For foster children, touch isn't always a comfort. Building trust and allowing children to join at their own pace is very important, especially for those who have been abused. 

Communicate Clearly

Use age and development-appropriate terms and language your foster child understands. For younger children, drawing pictures, playing with toys, or using sign language can help you connect and communicate with them.

Be Flexible

Children suffering from PTSD often feel numb for some time, even when they are in a safe space. Watch for signs of related mental illnesses, and be flexible as your child's behavior changes.

As children grow comfortable, they may have new behaviors to test the limits of rules or your support of them. As a parent, you might have to re-establish boundaries or create new ones. Lean on your foster child's care team, especially if you feel overwhelmed. Foster and foster-to-adopt parents are never alone, and your child's specialists will always be a first call for help and new ideas. 

Create Routines 

Routine is important to children growing up at all ages and stages. Foster children have all experienced a dramatic disruption in their lives and routines. Finding their way through the comforting ebb and flow of established routines is helpful, especially for younger children. For all kids, routines provide order and predictability to a world that may otherwise seem out of their control. 

Daily routines can include set times to eat together, read stories, or follow a bedtime ritual. Family traditions, such as singing, moving, or praying, can create routines that provide kids with predictability, comfort, and safety. 

Consider Nighttime triggers

Nightfall can mean increasing anxiety for children with PTSD. Use tuck-in time to talk, tell a story, or sing a lullaby. Allow children the grace to call or come and find you if they feel too scared to be alone in their rooms. Look for comfort items, like loveys, that can help them feel secure and build resilience over time. 

Help a Foster Child Heal in Your Forever Family

Do you feel called to adopt a foster child? AdoptionVA is focused on guiding foster-to-adopt parents seamlessly through the process. We partner with Extra Special Parents (ESP), a child-placing agency for foster children in Virginia. Our mutual goal is to help adoptive parents welcome foster children who will thrive and grow as part of your family. 

Foster parenting plays a critical role in child and family care. Adoptive parents must obtain a license as foster parents in Virginia before completing the adoption process. Learn more about adopting a foster child or take the first steps today. Tell me more!