Mental health is a large focus with children in foster care because every child who has entered care has experienced abuse or neglect in one way or another. According to safy.org, nearly 80% of American children in foster care suffer from a significant mental health issue, which is nearly four to five times that within the general population. There are many mental health diagnoses that these children experience. For this article, we will be focusing on ADHD, or Attention Deficit Hyperactivity Disorder.
Psychiatry.org defines ADHD as one of the most common mental disorders affecting children with symptoms including inattention, hyperactivity, and impulsivity. It is more popular in boys than girls and is often first identified in school-aged children when it leads to disruption in the classroom or problems with schoolwork.
Psychiatryadvisor.com summarizes findings from studies stating that they found more than one in four children in foster care are diagnosed with ADHD compared with one in fourteen children in Medicaid who received the same diagnosis. Additionally, about half of the foster children diagnosed with ADHD are also diagnosed with another disorder such as oppositional defiant disorder, depression, or anxiety compared with one-third of children with ADHD in Medicaid. It goes on to state that foster children with ADHD, however, are more likely to receive psychological services than children in Medicaid. It should be noted that behavior therapy is recommended as first-line treatment for young children with ADHD, and a combination of behavior therapy and medication is recommended for school-aged children. There is some debate about medicating children with a new diagnosis of ADHD without utilizing psychological services first.
There is additional debate regarding the actual diagnosis of ADHD versus trauma of children in foster care, according to chadd.org. Often children inherit ADHD from their birth parents. If a child experiences trauma, the symptoms are often similar to those attributed to ADHD. The trauma needs to be treated, not just ADHD. Grief and fear stemming from trauma will often look like a child is not focused or paying attention in school- if a child is worried about never seeing his or her parents again, it is certainly understandable why they wouldn’t be able to focus on math and reading, or why they may be experiencing disruptive behaviors. It is important to focus on helping children cope with the grief, loss, possible feelings of guilt, and utilizing appropriate social interactions to help them function in their everyday lives.
In addition to treating the trauma that these children have experienced, there are certainly children who require additional treatment for ADHD. First we need to be able to identify from a trauma-informed standpoint that a child who is acting out may not know how to communicate in another way that we would deem appropriate. For this, behavior management techniques should be utilized as part of a daily schedule and not just when the child displays disruptive behaviors. It should become the child’s norm so that the child knows how to cope before having explosive behaviors, rather than trying to calm down after. Some examples might include having a set schedule where the child is fully aware of expectations, setting time aside to practice deep breathing exercises, or designating sensory breaks allowing the child to expel excess energy (go for a 10 minute walk, do jumping jacks, play on the trampoline, etc.).
For many children, medication works well in conjunction with behavior management techniques and therapy. According to kidshealth.org, ADHD medicines improve attention by helping normal brain chemicals work better. The medicines target dopamine and norepinephrine, affecting a person’s attention and concentration. There are many different medications that a doctor may prescribe, and the dosage will have to be tailored to a child’s specific needs. A child may experience severe side effects on one medication, and no side effects on another.
The best way to address ADHD with children in care is to educate ourselves, and utilize services available to us and to our children. A trauma assessment is a great place to start, which will help identify specific areas to focus on. Ongoing trauma training for all foster parents is a must- the mental health field can change rapidly and continuing to attend trauma training on an annual basis will help provide foster parents with additional behavioral tools to utilize. Participation in behavioral therapy for the child, receiving an IEP in school, and having a set schedule including specific exercises to help the child succeed are all resources and tools that are easily accessible. Medication is available to be prescribed by a psychiatrist or a primary care physician if the diagnosis is documented. There are many ways to provide children with the services and resources needed to succeed, and many trainings and resources for foster parents to learn how to develop parenting techniques that will be successful. As always, if you have any questions about the availability of services and resources, contact your worker- we are here to help!
Additional information can be found at the following sites:
https://www.psychiatry.org/patients-families/adhd/what-is-adhd
https://www.safy.org/mental-health-among-children-in-foster-care/
https://chadd.org/adhd-weekly/trauma-and-adhd-co-exist-in-foster-children/
