Impact of relational trauma on children and foster carers of children who are looked after away from home

Abstract

Background: Maltreated children, including those who are looked after away from home, are amongst the most vulnerable members of society. Due to the relational trauma that most looked after children have experienced they are at increased risk of attachment and mental health difficulties, which can impede their ability to form close relationships with new carers. Indeed, many such children behave in ways that fail to elicit caregiving or even as if they do not need caregivers, and providing sensitive, therapeutic care to these vulnerable children can be a considerable challenge. Aims: The aims of this thesis were threefold: to review the impact of maltreatment experiences on children’s executive functioning, to investigate the prevalence of attachment and trauma-related difficulties in children in foster care, and their impact on the parenting task of foster carers. Methods: Aims are addressed in two journal articles. To address the first aim, a systematic review of research regarding the association between maltreatment and executive function in children and adolescents is presented in journal article one. Subsequent aims are addressed in journal article two, a cross-sectional study with foster carers of children in care aged 3-12 years who completed self-report measures investigating the emotional, behavioural, attachment and trauma related difficulties of their foster child, the perceived quality of the relationship, and levels of parenting stress and sense of competence. Results: The systematic review revealed that the majority of studies demonstrated a significant impairment in one or more areas of executive ability in maltreated children, with particular support for impairments in inhibitory control, executive working memory and decision making. However, there was only limited support for impairments in cognitive flexibility, planning/problem solving, and fluency. Furthermore, there was considerable variability between studies in the specific deficits reported. Results from the empirical study highlight the prevalence of attachment and trauma-related difficulties in children in foster care. Hierarchical regression analyses revealed that levels of foster carer-rated inhibited attachment behaviour was a significant predictor of quality of the foster carer-child relationship and parenting stress. The level of emotional and behavioural difficulties also emerged as a significant predictor of quality of the foster carer-child relationship, and parenting sense of competence. Conclusions: This thesis highlights the pervasive impact of relational trauma on children. Results of the systematic review indicate its impact on children’s executive ability. The empirical study reveals the high prevalence of attachment and trauma-related difficulties in children in foster care, and provides insight into factors related to quality of the foster carer-child relationship, and the stress and sense of competence of foster carers. Implications for interventions and service provision regarding maltreated children who become looked after away from home, and their carers, are discussed.