Frequent moves don’t just harm foster kids’ emotions — they hurt their brains
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Throwaway Kids - Part Three of Six
Star investigation reveals stark outcomes for America’s foster care children.
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‘The state that neglected me as a kid is the same state that wants to kill me’
When she was in foster care — her clothes in bags, uprooted and shuttled from one strange home to the next — Desi Henderson thought next to nothing about the wrong it might be doing to her brain.
Now, at 19, and studying to be the kind of teacher who gave her hope, the Tulsa, Oklahoma, teen who “aged out” of foster care last year looks back and thinks, “Oh, yeah. Definitely.”
Twelve different families in 18 years, not counting abusive stints back and forth to a mother who sold her child’s body for drug money: Kids don’t go through that much disruption, science is showing, without it inflicting a cognitive price.
“I remember as a kid wishing I could cement myself down so I didn’t have to go somewhere else with someone else,” Henderson said. “Most of these houses look relatively OK on the outside. . . . But you never know what goes on behind closed doors.
“I attempted suicide in two of these houses. I dealt with self harm in five. I had a gun held to my head in one. I was sexually assaulted in two. But I was loved and cherished in six of them. I had a family in six of them.”
While Henderson wound her way through a chaotic life, vowing to prove wrong all those who predicted she would turn out like her mother, researchers across the country had been looking into both the behaviors and brain development of foster kids just like her.
What they are discovering in ever-emerging research is just how much damage is being done to foster kids forced to go from one to two to 10 to 30 to, as an investigation by The Star has found, up to 100 different placements in childhood.
Perhaps most intriguing is what researchers are seeing unfolding in their brains.
In an effort to stop child welfare agencies from putting foster kids through multiple placements, attorneys in at least two class-action lawsuits — one in Kansas, another in Florida — seized on a 2013 paper published in Child Welfare on more than a decade’s worth of broad research.
In the paper, University of Oregon psychologist Philip Fisher, director of the university’s Stress Neurobiology and Prevention Lab, states directly:
“The available empirical evidence suggests that placement instability and other family chaos is associated with disrupted development of the brain’s prefrontal cortex.”
Located behind the forehead, the prefrontal cortex is the font of judgment and “executive functioning.” It takes the lead in focus, attention and planning, managing emotions, short-term memory and controlling impulses, like acting rashly on a thought or emotion.
Scientists so far have not established a precise cause-and-effect relationship that says X number of placements alter the brain by X amount. Because abuse and neglect and foster care are inseparable, it is still debatable how much of the problems scientists are finding come from the placements and how much from the abuse, neglect and what collectively are known as adverse childhood experiences, or ACES.
For some 20 years, since the Centers for Disease Control and Prevention and Kaiser Permanente published the first major ACES study in 1998, it’s become ever more clear that the higher one’s ACES score (meaning the more adverse and traumatic experiences one has as a child), the worse they tend to do as an adult.
In 2005, researchers at Harvard Medical School, the University of Michigan and the Seattle-based Casey Family Programs interviewed close to 500 former foster kids and found 25 percent suffered post-traumatic stress disorder, outpacing the 20 percent suffered by veterans of the war in Iraq and more than double the 11 percent suffered by veterans of the war in Afghanistan.
The latest research on foster children takes foster care research steps further, showing that no matter what crisis thrust a child into foster care, forcing that child to endure multiple placements is with little doubt adding brain insult to injury.
The implication already is that the repeated unpredictability and randomness of the lives of foster kids who are shuttled to a different place by the week, month or year is hurting the normal development and thus function of the prefrontal cortex.
The result, researchers suspect, is foster kids are put at greater risk of post-traumatic stress disorder, disruptive behaviors, drug and alcohol abuse and a range of psychiatric disorders from acting out to depression.
Henderson relates. She’s been in therapy and on medications since elementary school. She used to cut herself, etching ribbons into her skin in moments of turmoil. “I didn’t want to feel the emotional pain, so why not make myself feel the physical pain?” she said.
In one foster home, she would literally shut herself off, hiding in closets.
“The mom would get angry with me a lot,” Henderson said, “because I would get mad and I would yell at the other kids or I would freak out. If anything got too hard, I would like run away and hide. I would just go until somebody found me or until I calmed down or got hungry or hot.
“I think I always just wanted to go home and I never really knew what home was. But it was never where I was.”
A ‘structural problem’ in the brain
What’s happening in the brains of passed-around children is, in some regards, literally as clear as day and night.
The “day-night task” is a psychological measurement.
At the University of Delaware, researcher Mary Dozier and her colleagues in the Department of Psychological and Brain Sciences used it to assess 102 kids ages 5 and 6. The kids were broken into three groups: children never placed in foster care, kids adopted after one foster care placement and kids adopted after experiencing multiple placements.
The day-night task measures “inhibitory control.” It is the crucial ability — one of the executive functions of the prefrontal cortex — to control your behavior, inhibit yourself from acting on impulse.
Society relies on inhibitory control. Instead of running a red light, expressing random thoughts, gobbling all the buffet desserts, lashing out at a jerk in traffic, people learn to exercise self-control. They hold back.
In her lab, Dozier’s team showed kids a stack of random cards: White cards bore the image of a yellow sun; black cards bore a white crescent moon and stars. The children were instructed:
“When you see this card (sun), I want you to say ‘night.’ And when you see this card (moon and stars) I want you to say ‘day.’”
Instead of reflexively saying “day” at the sight of the sun and “night” at the image of the moon, the children needed to show restraint and, card after card, do the opposite.
Result: “Adopted children who had experienced placement instability performed worse . . .than both other groups,” Dozier concluded.
Inhibitory control was compromised. Hers is hardly the only lab finding this result.
At the non-profit Oregon Social Learning Center, research scientist Jacqueline Bruce, along with Fisher and colleague Katherine Pears, tested 117 foster kids and also found that more placements equaled less inhibitory control.
“Kids who had more placements had a harder time,” Bruce said. “They made more mistakes than kids who were in less placements.”
The result may seem insignificant, but it’s far from it.
“I mean, yes, it’s like what do we care if a kid can say ‘sun’ or ‘moon’?” Pears said. “But what we care about is that when you’re a kindergartner and you go to school and somebody knocks your pencil off the table and you want to punch them — you don’t! You inhibit that response and you do something that is socially acceptable.
“Or you’re in a new foster home, and your new foster sibling knocks your favorite Matchbox car off the table. Again, if you hit that kid, you’re out of there. It can get you in trouble again and again and again.”
Such trouble easily leads to repeated school failures, discipline, children being booted from one placement to the next.
“What happens is that these kids get rejected,” Pears said. “They get given up on. They tick off adults. People say, ‘Oh, we can’t do anything with that child. He just doesn’t care.’
“What people need to understand is that what looks like, ‘Oh, they’re not listening. They don’t care. They don’t want to behave,’ is that it’s not a situation of won’t do. It’s a can’t do.
“They don’t have the skills. Their underlying architecture is compromised. It’s a structural problem.”
Pears, Bruce and Fisher know this because, in at least one small study, they have taken pictures, functional MRIs of the brains of 11 foster kids versus 11 non-foster kids between the ages of 9 and 11 while they were being tested for inhibitory control.
This time the test was the “Go/No-Go” task. Kids are supposed to tap a button— the “go” action — every time they see a letter pop up on a screen, except when they see the letter “X,” the “no-go” action.
The experiment wasn’t looking at the effect of multiple placements. The researchers simply wanted to record some of what was going on in the brains of abused and neglected kids versus kids who weren’t abused or neglected.
Interestingly, the test results turned out even. Foster kids and non-foster kids performed essentially the same on the Go/No-Go task. But when the researchers looked at the brain MRIs, glowing in red and yellow, the differences became clear.
“The kids who have early adverse experiences show different patterns of brain activity than kids who don’t,” Bruce said. “There are different areas that are lighting up.”
Both lit up in an area known as the anterior cingulate gyrus, a crescent of neurons that up front and up top has ties to the brain’s cognitive prefrontal cortex. At the back and on the bottom it ties to the brain’s more emotional limbic system.
Whereas the non-foster kids were lighting up near the thinking prefrontal cortex, the maltreated kids in foster care were lighting up closer to the more emotional regions. In short, their brains were working differently.
‘A lonely, broken kid’
Additional studies by Dozier, the Oregon researchers and others have probed and also found differences in the stress response in foster kids.
It, too, begins in the brain.
Stress involves the body’s HPA-axis, so-called because it starts at the base of the brain in the hypothalamus. The hypothalamus, “H,” sends hormones a short distance away to the brain’s pea-sized pituitary gland, “P.” That gland, in turn, rushes its own hormones through the body to the adrenal glands, “A,” set atop the kidneys.
The adrenal glands spout the hormone cortisol, which is critical to a host of functions. Chief among them are two types of stress.
First, there’s sudden fight-or-flight. “If you’re gonna do public speaking,” Dozier said, “you’re going to have a high level of cortisol.”
The second is cortisol’s “diurnal” or daily function.
In the morning, when people rise, cortisol shoots up, hitting a peak about 30 minutes after waking to provide energy to take on the day. It then drops sharply, tapering to near zero by bedtime to promote sleep.
“This is part of why jet lag is problematic,” Dozier explained. It’s the cortisol cycle. “It takes you a couple of days for your system — cortisol being part of that system — to adjust to the new daylight cycle.”
But the problem in foster kids is hardly jet lag. What researchers suspect is that repeated trauma has caused the kids’ HPA axes to go on chronic high alert and become dysregulated.
Researchers suspect that just as a transmission pushed to run too hard, too long and too fast at high revolutions per minute needs to shift to a lower rpm, the daily cortisol cycles in many maltreated foster kids have likewise, by necessity, “down regulated.” They’ve become what they call “blunted.”
“I think it’s where the HPA axis is sort of saying, ‘OK, I just can’t keep elevating like this,’” Bruce said.
So when foster kids wake, their cortisol levels are often not as high as other kids’. When they go to bed, they’re not as low.
“It’s just flatter,” Dozier said. “The daily cycle has been thrown off.”
The problem with a dysregulated HPA system is its link to a mass of cognitive and emotional problems: PTSD, anxiety, depression and disruptive disorders where kids act stubborn, difficult, disobedient, irritable. Others turn inward. They tend to internalize their loneliness and withdraw.
“I mean, absolutely, I think I’m still affected by it,” said Katarina Sayally, 24, of Oakland, California. She was shuttled to 32 different foster placements, 28 of them before age 10. At age 11, she was sexually assaulted by one of her foster fathers.
Her first placement: 6 months old.
“I was born with drugs in my system,” Sayally said.
Sayally is one of 36 California foster children who appear on a video for California Youth Connection as part of a campaign to pass a bill, signed into law last year, to assure greater stability for foster children.
Genesis Osuna, 23, is also on it. She had three foster care placements, but moved at least six or seven times between them and a violent, paranoid mother who once sliced her with a knife.
In one foster home, the parents locked away the foster kids’ food. “There was one cabinet for the fosters and one cabinet for the bio kids,” she said. In a second home, foster kids snorted lines of cocaine in their rooms.
“I remember being such a lonely kid, a broken kid,” Osuna said.
Both have flourished, despite those experiences, and are among a very small percentage of former foster kids to graduate college.
Sayally earned her master’s degree in social work from the University of California, Berkeley. Osuna is on a full-ride scholarship to California State University, Fullerton. But neither thinks that multiple foster care placements improved their lives.
Sayally, with a bachelor’s degree in child development, believes she spent the first 22 years of her life in fight-or-flight. The evolving science, showing foster kids’ brains in a state of chronic stress, applied to her, she said.
“It started out, when I was younger, I called everyone mom. Every woman I met was ‘mom,’” said Sayally, who desperately sought to attach to someone. “It was really sad actually.”
Later: “I got angry. I would have angry outbursts. I would blow up and then I might throw stuff off the table. It wasn’t violence against people, but destruction of property.
“To be honest, I was just really confused and I was lonely. I felt like I didn’t belong to these random people or to these institutions.” On at least one occasion, Sayally ended up in congregate care, like a foster group home.
“I know a big part of me was testing people,” she said. “‘What are you going to do if I break something? Depending on how you react, maybe I can trust you. Will you love me if I do something bad?’”
The question, of course, is whether there are ways to correct the effects and give foster children a better chance.
To that, foster care researchers insist, yes, they believe there are. Perhaps not surprisingly, many have to do with caring for children in safe, nurturing and permanent places.
Orphans, Monkeys and other studies
What scientists know even better is what does not work.
Current studies are a direct extension of nearly 80 years of research. Much of it regards languishing “institutionalized” children left to founder in orphanages.
In the 1940s, René Spitz, an Austro-Hungarian psychoanalyst who later emigrated to the United States, was among the first to show the damage done by a lack of human contact. Films of his work with emotionally deprived children are easily found on YouTube.
Around the same time, British psychiatrist John Bowlby began work that would eventually lead to his famed “attachment theory.”
In a 1944 paper, “Forty-four juvenile thieves: their characters and home-life,” Bowlby found that 17 of the 44 young thieves he studied had been separated from their main caregivers for at least six months before age 5. The more often or longer they were separated, the less affection they showed.
With colleague Mary Ainsworth, he worked for decades to highlight the importance of having a mutually satisfying attachment to a parent or parent substitute.
Then there are the monkeys.
By any modern ethical standard, the experiments conducted by psychologist Harry Harlow in the 1950s and ‘60s would be considered cruel and inhumane. They were also groundbreaking.
“He really started out with the parent/child relationship,” said Deborah Blum, director of the Knight Science Journalism program at MIT and author of “Love at Goon Park: Harry Harlow and the Science of Affection.” “I think the way Harlow put it is that no one develops healthy and normal without ‘a solid foundation of affection.’”
It raises the question of what happens to humans if that foundational relationship can never be repaired, or an attachment is never properly formed.
“So you have this first damaging relationship,” Blum said. “Your biological parents are terrible people. They may be damaged themselves. And they reject you. Or they abuse you. The state, to protect you, takes you away and puts you into foster care.
“Now you have this chance, essentially, of repairing that foundational relationship with your foster family. But then that relationship doesn’t work. So you go to another one and to another one. It’s the Bowlby thing. You’re never going to form that kind of attachment that allows you to plant your feet on solid ground and feel loved and feel cared for.”
Between then and now, numerous studies have found other neural effects of abuse and neglect, all of which potentially affect foster kids. Brain mass has shown to be smaller in several regions that include the corpus callosum, which helps the two sides of the brain communicate, and the regions that control emotion and memory.
Charles Zeanah has witnessed the effects first hand.
A psychiatrist at Tulane University in New Orleans, Zeanah is one of the three prime investigators in the Bucharest Early Intervention Project. In 2000, he along with researchers at Harvard University and the University of Maryland began tracking 136 pre-school children who were being raised in Romanian orphanages.
Half the kids stayed in the orphanages; half were placed in stable foster homes where the parents were trained as part of a specially-designed program. Those two groups were compared to a third group of 76 kids who had never been institutionalized.
The results were “profound,” Zeanah told The Star. The work, which has tracked the children into their late teens, is considered important because some 6 million to 8 million children worldwide are still being raised in orphanages. Foster care is a rarity in much of the world.
“We did a comprehensive assessment,” Zeanah said, looking at a range of measures. “Height, weight, head circumference, physical characteristics, emotional responsiveness, social responsiveness, cognition.”
MRI’s measured the brain’s gray matter and its deeper white matter, showing less volume in both.
Institutionalized kids showed multiple delays. None of the kids did as well as those who were never institutionalized. But, notably important, the children who were put in stable foster care did show improvement.
“The sooner you get the kid into an adequate care-giving environment,” Zeanah said, “the more likely they are to recover — and the fuller their recovery is likely to be.”
Adequate doesn’t mean moving from place to place. Zeanah, in New Orleans, is also director of a community-based intervention program. “I deal with foster kids on an almost daily basis,” he said.
“You know, as bad as these disruptions are for older kids,” he said of multiple placements, “they’re even worse for younger kids.”
Consistency and predictability, researchers insist, is an important key to success.
“I try to talk to people in child welfare about this,” Zeanah said. “The young child has no way of understanding what is happening. Someone drives up in a white station wagon, straps them to the back seat and takes them over to someplace they’ve never been before. They have no way of understanding why that happened. And when that happens multiple times, they begin to think, ‘You know, this is the way the world works.’”
Zeanah recounted the story of a 5-year-old girl who had been through multiple placements, and had just been adopted by her new mom, an interior designer. Sensitive to the affect the disruptions might have had on the child, the adoptive mom took the child to work with her so they wouldn’t be separated.
They arrived at the client’s house.
“They walk in the home,” Zeanah said, “and the little girl goes to the woman’s living room, lies on the floor, takes her raincoat off and covers her head up with the raincoat.”
The adoptive mother is embarrassed, apologizes to the client.
“She gets out in the car with the little girl and says, ‘Hon, you know, that is that lady’s home,’” Zeanah recounted. “You can’t just go in and lie down on the floor and cover yourself up. Why did you do that?’
“The girl said, ‘I thought it was my new home.’”
Foster care advocates, testing new interventions, are trying to help bring greater stability to the lives of foster kids. Many take brain development into account.
One, the Quality Parenting Initiative, started in Florida in 2008, is being used in 70 jurisdictions in nine other states: California, Illinois, Louisiana, Minnesota, Nevada, Ohio, Pennsylvania, Texas and Wisconsin.
Dozier, the researcher out of Delaware, has developed an approach, known as Attachment Behavioral Catch-Up (ABC), that has been shown to help normalize levels of the stress hormone, cortisol, in foster kids. Fisher and colleagues in Oregon have developed the Treatment Foster Care Oregon for Preschoolers, formerly the MTFC-P, which studies have shown also help normalize cortisol and reduce problem behaviors.
Henderson, in Tulsa, and the other former foster kids insist that their salvation had almost nothing to do with the system charged with protecting and raising them.
“I just think there’s something deep inside of me that always wanted to be better,” Henderson said. “I mean, a lot of people were like, ‘You’re going to turn out like your mom. You’re never going to be better.’”
Research into resilience continually reinforces the importance of supportive relationships, often described as having at least one reliable person in life to count on.
Henderson said she learned what a better life was supposed to be by watching her friends. She observed her friends’ parents.
“Just watching the ways they interacted. I mean, it just taught me how to be a basic human,” she said.
Henderson currently lives in her own apartment, works a full-time job at Starbucks inside a Target, and attends community college three mornings a week. For her, school became a refuge. She felt lucky to remain in the same district through much of her time in foster care. Her teachers, whom she called her “solids,” offered the stability that multiple foster care placements did not.
Osuna said that for her, it was her school counselor. “I call my school counselor my mom,” she said. “We talk every day, every day. I don’t know how I would have gotten through college without her. I don’t know how I would have survived without her.”
Sayally knows that because she has her master’s degree that some see her as a foster care success story. But she said she thinks that’s the wrong message to take away. She considers herself a survivor, an exception to the rule.
“What foster care did to me: I ended up living in a homeless shelter longer than I ever lived in a home,” Sayally said.
Four years in the same Humboldt County high school provided her the most stability she ever had. She is unsure how she would have survived were it not for an administration and some teachers who believed in her, encouraged her and showed her what she called “tough love.”
That hundreds of thousands of other foster children never reach safe harbor is evidence of a system that is not working, she said.
“I’m 24 and considered pseudo-successful because I have these letters behind my name,” Sayally said of her college degrees. “But my success is not a reflection of the system’s successes. It’s a reflection of a system that failed every other young person who had the potential to achieve their dreams and weren’t given the chance to do so.”
This story was originally published December 15, 2019 at 5:00 AM.
