FOSTER CARE/ADOPTION
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I work with children in the foster care system and who have been adopted. Based on my experience, there are certain agencies that I will not work with. I limited the amount of children I work with who are in foster care. I don't limit the amount of children that have been adopted that I am willing to work with. Children who are in the foster care system or have been in the foster care system experience many unique challanges that are often overlooked and/or misunderstood by the courts, child welfare professionals, teachers, school personnel, etc.
There are several areas that I consider when working with children in foster care or who have been adopted. The first area is how was the pregnancy for the biological mom. Was it an extremely stressful pregnancy? Did she receive prenatal care? Did she use substances while she was pregnant?
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In utero substance exposure can introduce harmful substances to the developing fetus. This exposure can have significant, long-term effects on brain development and overall health in children. Substances such as alcohol, nicotine, cocaine, and opioids can disrupt crucial stages of fetal brain growth, leading to developmental delays, cognitive impairments, and behavioral problems that persist into childhood and even adulthood.
One of the most well-documented consequences of in utero substance exposure is the impact of alcohol on fetal brain development, which can lead to Fetal Alcohol Spectrum Disorders (FASD). Alcohol crosses the placenta and can interfere with the normal development of neurons and brain structures, especially during the first trimester when much of the brain's foundation is being formed.
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Children with FASD may experience a range of issues, from mild learning disabilities to severe intellectual disabilities. They may have difficulty with attention, memory, and problem-solving, and often struggle with impulse control and emotional regulation. In severe cases, children may exhibit distinct physical features such as a thin upper lip, small eye openings, and growth deficiencies. These cognitive and behavioral challenges make it difficult for children with FASD to succeed academically and socially, often leading to lifelong impairments.
Nicotine exposure during pregnancy, often due to smoking or vaping, also has significant effects on fetal brain development. Nicotine restricts blood flow and reduces the amount of oxygen reaching the developing fetus, which is critical for healthy brain growth. This disruption in oxygen supply can result in lower birth weight, reduced brain volume, and structural brain abnormalities.
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Children exposed to nicotine in utero are at higher risk for cognitive deficits, such as problems with attention, hyperactivity, and executive functioning. Research has shown a strong link between prenatal nicotine exposure and attention-deficit hyperactivity disorder (ADHD). These children may struggle with focusing on tasks, managing impulses, and regulating their behavior, leading to academic and social difficulties. The long-term effects of nicotine exposure are also associated with increased risks of learning disabilities and developmental delays.
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Cocaine, a powerful stimulant, can have serious consequences on fetal brain development when used during pregnancy. Cocaine interferes with the function of neurotransmitters like dopamine and serotonin, which are essential for brain development. This disruption can affect the formation of neural connections and the regulation of important brain processes.
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Children exposed to cocaine in utero may experience emotional and behavioral difficulties. They are often more prone to irritability, hyperactivity, and aggression, and they may have difficulty managing stress and frustration. These children are also at increased risk for emotional regulation problems, including mood swings and difficulty forming healthy attachments. The developmental impact of cocaine exposure can extend to cognitive impairments, such as difficulties with memory, attention, and language processing.
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The opioid epidemic has drawn attention to the serious consequences of opioid use during pregnancy. In utero exposure to opioids, including prescription painkillers and illicit drugs like heroin, can lead to a condition known as Neonatal Abstinence Syndrome (NAS). Babies born with NAS experience withdrawal symptoms shortly after birth, including tremors, irritability, feeding difficulties, and seizures. This condition requires immediate medical intervention and prolonged hospital stays for newborns.
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Beyond the initial withdrawal period, opioid exposure can also impair long-term brain development. Children exposed to opioids in utero are at higher risk for developmental delays, cognitive impairments, and difficulties with motor coordination. These children often struggle with executive functioning skills, such as planning, problem-solving, and self-control. Additionally, opioid-exposed children may experience emotional and behavioral challenges similar to those seen in other forms of substance exposure, such as increased anxiety, mood disorders, and difficulties with social interaction.
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For this issue, I may recommend seeing a neurologist (if the child hasn't already seen one) and/or neuropsychological testing to ensure the brain is working as it should, with a focus on memory and executive functioning. I believe in the power of play therapy to help with these issues.
The second area that I pay attention to is what brought the child into care. I believe that neglect is the most damaging forms of abuse there is, significantly affecting a child's emotional, cognitive, and physical development. Unlike abuse, which often involves active harm, neglect is characterized by a lack of essential care, love, and support. This absence of necessary attention can create profound and lasting effects on a child's development.
Children rely on their caregivers to meet their emotional needs, providing affection, safety, and guidance. When these needs are neglected, children often develop low self-esteem, chronic anxiety, and difficulties in forming healthy relationships. A neglected child may struggle with attachment issues, fearing abandonment or becoming overly dependent on others for validation. This emotional insecurity can extend into adolescence and adulthood, resulting in difficulty managing emotions, establishing trust, and building stable relationships.
Neglect can severly impact a childs cognitive development, particularly during the early years when the brain is most malleable. Children need consistent stimulation, such as interaction, play, and verbal communication, to develop language, problem-solving and critical thinking skills. In neglected environments, where this stimulation is lacking, cognitive delays often occur. Neglected children may struggle academically, showing poor attention, delayed language skills, and lower IQ levels compared to their peers. These cognitive deficits can persist into adulthood, limiting educational and employment opportunities.
The physical effects of neglect are equally concerning. Inadequate access to nutrition, medical care, and a safe living environment can stunt a child’s growth and development. Neglect often leads to malnutrition, chronic illnesses, or untreated medical conditions, which can have lifelong consequences. Neglected children may also experience delays in motor skill development, failing to reach typical milestones such as walking or coordination in a timely manner.
Children who grow up in neglectful environments often struggle with social interactions. Without proper modeling of social skills from caregivers, they may not know how to interact appropriately with peers or authority figures. They may become withdrawn, aggressive, or engage in risk-taking behaviors as a way of coping with their unmet needs. Neglect is also strongly associated with behavioral disorders such as oppositional defiant disorder (ODD) or conduct disorder, which further complicates their ability to thrive socially.
The long-term effects of neglect can persist well into adulthood. Many neglected children grow up to experience mental health issues such as depression, anxiety, and post-traumatic stress disorder (PTSD). They may also struggle with substance abuse or become involved in unhealthy relationships as a result of their impaired ability to form secure attachments. In some cases, the cycle of neglect continues across generations, as those who were neglected as children may have difficulty providing proper care to their own children.
This issue often requires a variety of interventions. Some of the services I may recommend include: speech and language evaluation, physical therapy evaluation, sleep study, occupational therapy evaluation, an attachment assessment, auditory processing evaluation, psychological evaluation, to see a behavioral optometrist, to see a developmental pediatrician, autism evaluation, request IEP testing/504 with your child's school, and/or psychiatric evaluation. Again, I can emphasize the importance of play therapy to help with these issues.
The third area that I consider is casual reasoning. The lack of casual reasoning often is misunderstand and the most frustrating for parents/caregivers. Neglect, particularly in early childhood, can have profound effects on a child’s ability to develop causal reasoning, the cognitive process of understanding cause-and-effect relationships. Causal reasoning is a fundamental skill that enables individuals to make sense of the world, predict outcomes, and solve problems. For children, it emerges through exploration, interaction, and consistent feedback from caregivers. Neglect, however, disrupts these necessary experiences, hindering the development of this crucial cognitive function.
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Neglect occurs when a child’s basic needs—whether emotional, physical, or psychological—are not adequately met by caregivers. Unlike abuse, which involves overt harm, neglect is characterized by the absence of care and attention. This can take many forms, such as emotional neglect, where caregivers fail to provide love and affection, or physical neglect, where children are deprived of necessities like food, shelter, and medical care. The lack of stimulation and nurturing in neglectful environments severely limits a child’s learning opportunities and engagement with the world, both of which are essential for developing causal reasoning.
Causal reasoning is a cognitive skill that begins developing in infancy. Babies learn through repeated interactions that their actions lead to certain outcomes: crying brings attention, reaching for an object allows them to grasp it, and pushing a toy makes it move. As children grow, their understanding of cause-and-effect relationships becomes more sophisticated. They learn to predict consequences, solve problems, and understand the relationship between actions and results.
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For causal reasoning to develop effectively, children need consistent feedback from their environment. They must be allowed to experiment, receive responses from caregivers, and engage with a world that reacts predictably to their actions. This process helps children learn how different factors are connected and how their behavior can influence outcomes.
Neglect disrupts this natural learning process. In a neglectful environment, caregivers may be emotionally unavailable, unresponsive, or absent, which deprives the child of the crucial feedback they need to understand cause and effect. For example, a child who cries may not receive attention or comfort, leading to confusion about whether their actions have any influence on the world. Without consistent responses from caregivers, children struggle to learn that their behavior can affect outcomes, which undermines their ability to develop causal reasoning.
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Additionally, children in neglectful situations may lack opportunities for exploration and play, both of which are critical for learning causal relationships. Without engaging in activities like building blocks, solving puzzles, or interacting with other children, their ability to test hypotheses, experiment with different actions, and observe consequences is greatly reduced. This limits their problem-solving abilities and impairs their understanding of how the world works.
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Neglect also has emotional consequences that affect causal reasoning. Children who experience neglect often develop feelings of helplessness, insecurity, and low self-worth. These emotional struggles can interfere with cognitive development, including causal reasoning. When a child feels that their actions do not matter or will not lead to positive outcomes, they may stop trying to influence their environment altogether. This learned helplessness can cause children to disengage from problem-solving and critical thinking, reinforcing the cycle of neglect and cognitive stagnation.
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Moreover, emotional neglect can impair a child’s ability to develop the self-regulation skills needed for effective reasoning. In a supportive environment, children learn to manage frustration and persist in problem-solving tasks. Neglected children, however, may lack the emotional resilience to cope with challenges, leading to frustration and withdrawal when faced with complex tasks that require causal thinking.
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The effects of neglect on causal reasoning can persist into adolescence and adulthood. Children who grow up in neglectful environments may struggle academically, particularly in subjects like math and science that require logical reasoning and problem-solving. They may also find it difficult to navigate social relationships, as understanding the consequences of their actions is key to building healthy interactions. In extreme cases, the lack of causal reasoning can lead to impulsive decision-making and an inability to foresee the long-term consequences of choices, which can result in problematic behaviors or life outcomes.
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In contrast, children who grow up in nurturing environments are more likely to develop strong reasoning skills, which help them navigate academic, social, and emotional challenges. This highlights the critical role of early intervention and supportive caregiving in fostering the cognitive and emotional development of children, particularly those at risk of neglect.
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These children are frustrating to parents/caregiver and teachers because consequences don't seem to work with them. Guess what? They don't, the child doesn't have the skill necessary to be impacted by a consequence. It is due to this lack of casual reasoning, that I recommend sticker charts, behavioral charts, rewards and punishments not be used with children who have difficulties with casual reasoning.
For this issue, I recommend play therapy and filial therapy skills training (i.e.., teaching parents to help organize their child's world for them and to facilitate reflective and attuned interactions with their child.
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Finally, and most importantly, the role of attachment cannot be overemphasized. This issue would take pages and pages to discuss. However, the most important aspects of it in my work with children in the foster care system or who have been adopted is parents/caregivers ability to reflect and repair.