Children who are placed in out-of-home care are likely to have experienced a range of early-life adversity. The range and complexity of these adverse circumstances are well known to practitioners, and they include trauma, abuse, neglect and antenatal substance exposure. The Adverse Childhood Experiences study (Anda, Felitti, & Bremner, 2006) has shown that this kind of exposure is associated with a range of adverse physical and mental health outcomes in adulthood (see also Price-Robertson, Higgins, & Vassallo, 2013).
Research suggests that the behavioural difficulties of many children in care are underpinned by cognitive vulnerabilities related to exposure to adverse and traumatic events in childhood. Indeed, children who are placed in out-of-home care experience higher levels of behavioural and mental health issues than children from similar backgrounds who are not in placed in care (Ford, Vostanis, Meltzer, & Goodman, 2007).
There has been a lot written about the effects that prolonged exposure to traumatic events is thought to have on brain development (see Atkinson, 2013; Cook, Blaustein, Spinazzola, & Van der Kolk, 2003; Cook et al., 2005; Perry, 2006, 2009; Van der Kolk et al., 2009). Many of the assumptions made in this literature have not been subject to critical review, despite the influence of these ideas in shaping service delivery for children in out-of-home care (see Box 1 for an overview). Similarly, there has not yet been any rigorous evaluation of the interventions that are being developed based on these assumptions.
While the broad symptoms of complex developmental trauma may well reflect the experiences of many children in care, other difficulties may be related not to trauma but to adversities such as antenatal alcohol exposure, placement instability, poverty, neglect and pervasive developmental issues (De Jong, 2010; Zilberstein & Popper, 2014). In other words, interventions that target complex trauma may be necessary, but not sufficient, to meet the developmental needs of children in care (Zilberstein & Popper, 2014).
Collectively, this research suggests that the brain development of children in care is likely to be affected in some way by their early experiences. The neuropsychological impact of adversity can vary widely, however, and not all children that experience adversity go on to develop difficulties related to learning, memory and attention. The impact of adversity on brain development may depend on whether children primarily have experienced deprivation or threat during their pre-care life: resulting in either delayed cognitive development or dis-integration of cognitive skills, respectively (see McLaughlin et al., 2014).
On the whole, neuropsychological studies tend to show that children who have experienced or witnessed violence, trauma, abuse or neglect do experience cognitive difficulties in one or more areas, when compared to children who haven’t experienced these adversities (McCrory et al., 2011; McLaughlin et al., 2014).
Some of the main cognitive difficulties are:
General cognitive and language delay
Problems with memory
Bias in the processing of social/emotional information
Executive functioning (cognitive flexibility and behaviour regulation)
Metacognitive skills
Behavioural regulation
Taken as a whole, the study suggests that children in care are likely to experience:
- compromised executive functioning;
- difficulty regulating arousal levels in response to emotional and sensory stimulation (high and low emotional responsiveness);
- difficulty with attention and memory;
- distinct patterns of social information processing;
- reactivity to sensory stimuli;
- disruptions to sleep and other circadian rhythms; and
- compromised language development, including difficulty in the comprehension and social use of language despite apparently adequate verbal abilities.