Addressing Common Mental Health Challenges In Foster Families

There are many reasons that a parent may not be able or allowed, by law, to care for their child. In such cases, the child is sometimes placed in a temporary living situation intended to allow them to grow in a stable environment until they can be permanently placed with a parent, relative, or adoptive family. According to the American Society for the Positive Care of Children (ASPCC), more than 437,000 children and adolescents live in foster care situations. Of these, 45% live with non-relative foster families and 32% live with a relative(s). 

Both children in foster care and those caring for them may experience a variety of mental health effects as a result of the inherent challenges of the situation. Here, we’ll introduce some of these key potential effects and suggest support resources for addressing them.

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Mental health in children in foster care

However, experts suggest that mental and behavioral health are the largest unmet health needs for children and teens in foster care. Even when foster families provide appropriate guidance, unconditional love, and a safe environment, studies repeatedly indicate that children in foster care experience higher rates of mental health disorders and are more likely to experience mental health disorders as they transition to adulthood. 

The challenges that children in the foster system face are often profoundly impactful, and addressing them is a deep responsibility for foster families. Examples of some of these challenges include the following:

• Children in foster care might miss their biological families, even if their living situation was abusive or they were neglected. 

• They may struggle to bond with their foster family, new friends, or peers at a new school.
• The prospect of potential reunification with their biological families can be complicated. For example, if the child has established a safe, comfortable life with their foster family, they might be reluctant to return to a potentially challenging situation with their family of origin. Additionally, there might be resentment towards the birth family, or the child might be fearful of starting again at a new school or in a new area.
• Children in foster care have often been exposed to adverse childhood experiences (ACEs) such as physical and psychological maltreatment, abuse and neglect, parental substance use disorders, and mental illness in the household. While not every child exposed to ACEs develops a mental health disorder, many do.

Common mental health disorders in children in foster care

Some mental health disorders that children who have spent time in foster care situations may be more likely to experience include: 

• Post-traumatic stress disorder (PTSD)
• Oppositional defiant disorder (ODD)
• Conduct disorder (CD)
• Major depressive disorder (MDD)
• Reactive attachment disorder (RAD)
• Anxiety disorders
• Attention-deficit/hyperactivity disorder (ADHD)
• Specific phobias
• Eating disorders
• Substance use disorders

Signs that a child in your care may need mental health support

It can be crucial for foster families to recognize symptoms of mental health challenges related to the child welfare of those in their care, since early intervention is often critical for successful treatment outcomes. While only a licensed healthcare professional can provide mental health diagnoses, recognizing potential symptoms can empower caregivers to seek out mental health care for the child or children as soon as possible.

Some potential warning signs of mental health challenges that could indicate that the child in your care likely needs professional support include, but are not limited to the following.

Flashbacks or nightmares of traumatic events

Children with PTSD may have recurrent, distressing thoughts and memories of the trauma they have experienced. This can lead to nightmares and flashbacks, in which the child involuntarily re-experiences elements of the past trauma. 

Social anxiety and/or withdrawal

Due to the disruptions, instability, and trauma children in foster care may experience, some may develop social anxiety or other social challenges. Social anxiety disorder in particular can cause intense, sustained fear of social or performance situations in which they might be exposed to judgment, scrutiny, or alienation. 

Hyperarousal

Children with PTSD or severe anxiety disorders may be easily startled or appear as if they are constantly “on edge.” These feelings and behaviors go beyond common nervousness and can interfere with the child’s ability to feel comfortable and function at home and school.

Irritability, fear, and excessive worry

These three feelings are common symptoms of anxiety disorders. Examples of anxiety-related disorders that can affect children include social anxiety disorder, panic disorder, generalized anxiety disorder, separation anxiety disorder, specific phobias, selective mutism, and obsessive-compulsive disorder (OCD).

Sadness, helplessness, and hopelessness

These are typical symptoms of depressive disorders. Children with these types of symptoms may also show consistently low mood and motivation. They may not take pleasure in activities that most children enjoy, and they may seem emotionally detached.

Aggression or “acting out”

Some children may exhibit aggressive or challenging behaviors towards their natural or foster families, particularly while trying to adjust to life in a new home. During this phase, they may act out by testing, ignoring, or blatantly defying rules set at home or in school. They might lie, steal, or show verbal or physical aggression towards others.

The reasons for these behaviors are typically complex. They’re often linked to deep-seated feelings of anger, resentment, fear, insecurity, uncertainty, and powerlessness. 

Sleep disruptions

Research indicates that children in the foster system often have problems with sleep disruptions and poor sleep quality. Examples include an inability or resistance to falling asleep, trouble staying asleep, nightmares, and bedwetting. These effects are often associated with past trauma and mental health challenges.

Disordered eating

Disordered patterns of eating are a common symptom of several mental disorders. In addition, children in the foster care system may also show signs of food hoarding—sometimes referred to as “food maintenance syndrome”—due to past experiences of food insecurity or neglect. In such cases, children may overeat at mealtimes or stockpile food items in hidden places. 

Problems with focus and concentration

Children in foster care may struggle to stay focused, which can lead to significant challenges for them at school, home, and other areas where concentration may be needed. There are several potential reasons for this difficulty, from past trauma to poor sleep. Attention-deficit/hyperactivity disorder (ADHD) could also be a contributing factor in some children. Studies suggest that the prevalence of ADHD diagnosis in foster children ranges from approximately 10–21%, which may be higher than the prevalence among children in general.

The importance of addressing mental health challenges like these

Mental health challenges like those covered here can have significant, far-reaching impacts on a child’s overall well-being in the present and into the future, including their emotional, social, and academic development. For example, children in the foster system may experience any of the following, particularly without professional mental health support:

• Troubles with academic performance
• Difficulty forming healthy attachments
• Social isolation
• Poor self-esteem
• Future mental health disorders
• Risk-taking and/or self-harming behaviors

If you are experiencing suicidal thoughts or urges, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 988 to talk to someone over SMS. Support is available 24/7.

For the child’s present and future well-being, seeking mental health care for them as needed is typically crucial. If you notice mental, emotional, or behavioral health symptoms in them, it’s recommended that you connect with a child psychologist with experience in trauma-informed care and children in the foster system to ensure they receive the support they may need.

Common mental health-related challenges for foster families

Foster parents may also face challenges that could impact their individual well-being. Beyond the basic challenges that come with providing a caring, nurturing environment for a child who may have experience with trauma and unstable living situations, foster families may also experience:

• Complicated or tumultuous interactions with the child’s family of origin
• Challenging behaviors exhibited by the child, associated with past trauma
• Challenges addressing diversity and cultural awareness
• Potential stigma and stereotypes surrounding the foster care system
• Disordered attachment styles themselves
• Caregiver burnout, stress, and related challenges
• Barriers to connecting with mental health resources or mental health treatment
• Emotional difficulties if the child is reunited with their birth family

Mental health strategies and support for foster families

Addressing mental health in foster families often begins with psychoeducation and training. When foster parents learn about the common mental health disorders that many children in the foster system face, it can help them recognize and get support in addressing any symptoms that may arise. It can also empower them to seek support for their own mental health as needed.

Training and support programs can teach foster parents how to provide trauma-informed care and help them learn positive, productive methods for handling challenging behaviors. Programs offering methods like parent-child interaction therapy may also improve the quality of life and overall well-being of foster children and their families.  

For these purposes, there are a variety of resources available for foster parents. Families may also benefit from seeking out support groups and mentorship opportunities, and a strong support network of family, friends, and loved ones can be crucial as well.

Online therapy for coping with family challenges

A key responsibility of a foster parent is to support the mental health and overall well-being of the child in their care. To do this, they typically must look after their own mental health and well-being, too. Meeting with a therapist regularly is one way to support this goal. Therapy can give foster parents a safe space to express their feelings, get emotional support, and learn coping techniques for the challenges of foster parenting.

For busy parents, commuting to and from in-person therapy appointments isn’t always feasible. In such cases, online therapy can offer busy families a flexible and more affordable alternative to conventional, in-office treatment. Virtual therapy allows parents to schedule sessions when it’s convenient for them—which they can attend remotely from anywhere they have an internet connection. Additionally, online therapy is often more affordable than traditional treatment without insurance coverage. Research also suggests that online therapy can be as effective as in-person therapy in many cases.