Child Development [11]

	Cognitive	Psychological	Moral	Sexual	Motor
0-6 months	Recognition of mother; no concept of past or future; reaches for familiar people or toys.	Attachment to mother/ caretaker; totally dependent; totally trusting; learns intimacy.	None	Erections possible; both sexes can be stimulated.	Sucking; hands clenched/ grip; neck muscles develop; pulls at clothing; laughs/ coos.
6-12 months	Objects can be held in memory; learns through routines and rewards; recognizes name; says two to three words besides “mama” and “dada”; imitates familiar words.	Separation from mother; begins to develop a sense of self; learns to get needs met; trusts adults; stretches arms to be picked up; likes to look at self in mirror.	None	Generalized genital play.	Rolls over; stands with sup-port; creeps/crawls; walks with help; rolls a ball in imitation of adult; pulls self to standing position and stands unaided; transfers object from one hand to the other; drops and picks up toy; feeds self cracker; holds cup with two hands; drinks with assistance; holds out arms and legs while being dressed.
12-18 months	Experiments with physical environment; understands the word “no”; comes when called to; recognizes words as symbols for objects (cat —meows); uses 10 to 20 words, including names; combines two words such as “daddy bye-bye”; waves good-bye and plays pat-a-cake; makes the sounds of familiar animals; gives a toy when asked; uses words such as “more” to make wants known; points to his/her toes, eyes, and nose; brings objects from another room when asked.	Early social development; egocentric; accepts limits; develops self-esteem (love from family); plays by self.	Fear of authority figures.	Continued generalized genital play.	Creeps up stairs; gets to standing position alone; walks alone; walks backward; picks up toys from floor without falling; pulls and pushes toys; seats self in child-size chair; moves to music; turns pages two or three at a time; scribbles; turns knobs; paints with whole arm movement; shifts hands; makes strokes; uses spoon with little spilling; drinks from cup with one hand unassisted; chews food; unzips large zipper; indicates toilet needs; removes shoes, socks, pants, sweater.
18-36 months	Can conduct experiments inside head but limited to experience; rapid language growth; copies adult chores in play; carries on conversation with self and dolls; asks “what’s that?” and “where’s my…?”; has 450-word vocabulary; gives first name; holds up fingers to tell age; combines nouns and verbs “mommy go”; refers to self as “me” rather than by name; tries to get adult attention, exclaiming “watch me”; likes to hear same story repeated; may say “no” when means “yes”; talks to other children as well as adults; names common pictures and things.	Autonomy struggles; learns system of meeting needs; social development increases; points to things he/she wants; joins in play with other children; shares toys; takes turns with assistance.	Knowledge of preferences of authority figures.	Continued generalized genital play; early sex-role development.	Can run, throw ball, kick ball, jump; goes up stairs with one hand held by adult; turns single pages; snips with scissors; holds crayon with thumb and fingers (not fist); uses one hand consis­tently in most activities; rolls, pounds, squeezes, and pulls clay; uses spoon with little spilling; gets drink from fountain or faucet independently; opens door by turning handle; takes off and puts on coat with assistance; washes and dries hands with assistance.
3-5 years	Can conduct experiments inside head; cannot sequence; capacity to use language expands; understands some abstract concepts: colors, numbers, shapes, time (hours, days, before/after); under­stands family relations (baby/ parent); can tell a story; has a sentence length of 4 to 5 words; has a vocabulary of nearly 1000 words; names at least one color; under­stands “tonight,” “summer,” “lunchtime,” “yesterday”; begins to obey requests like “put the block under the chair”; knows his/her last name, name of street on which he/she lives and several nursery rhymes; uses past tense correctly; can speak of imaginary conditions “I hope”; identifies shapes.	Can cooperate; self-perceptions develop; cannot separate fantasy from reality; has nightmares; models on same-sexed parent; experiences and copes with feelings (sad, jealous, embarrassed); plays and interacts with other children; dramatic play is closer to reality, with attention paid to detail, time, and space; plays dress-up.	Self-esteem dependent on authority figures; follows peers’ fads; negotiates to get needs met.	Generalized genital play in males; masturbation to orgasm in females is possible; early experimentation; gender identity established.	Swings/climbs; uses small scissors; jumps in place; walks on tiptoes; balances on one foot; rides a tricycle; begins to skip; runs well; bathes and dresses; runs around obstacles; walks on a line; pushes, pulls, steers wheeled toys; uses slide independently; throws ball overhead; catches a bounced ball; drives nails and pegs; skates; jumps rope; pastes and glues appropriately; skips on alternating feet; pours well from small pitcher; spreads soft butter with knife; buttons and unbuttons large buttons; washes hands independently; blows nose when reminded; uses toilet independently.
6-9 years	Can think using symbols; can recognize differences; makes comparisons; can take another’s perspective; defines objects by their use; knows spatial relationships like “on top,” “behind,” “far,” and “near”; knows address; identifies penny, nickel, dime; knows common opposites like “big/ little”; asks questions for information; distinguishes left from right.	Early close peer relationships; presence of well-developed defenses; develops identity outside family (school, friends); has likes and dislikes (food, friends, games); chooses own friends; plays simple table games; plays competitive games; engages in coopera­tive play with other children involving group decisions, role assignments, fair play.	Has a conscience; refinements in moral development.	Defenses reduce experimen­tation, but some continues.	Is increasing small muscle motor skills; cuts foods with a knife; laces shoes; dresses self completely; ties bow; brushes independently; crosses streets safely.
10-15 years	Can engage in inductive and deductive logic; neurons are present; understands hypothetical situations; conflicts with parents increase.	Increased autonomy struggles; increased focus on identity; focus on peer relation­ships; rebellious; often moody; romantic feelings; struggle with sense of identity; feels awkward or strange about his/her body; worries about being normal; frequently changing relationships.	Moral development is legalistic; recognition of principles (e.g., justice); selection of role models.	Puberty; sex organs mature; males ejaculate and have wet dreams; both sexes able to masturbate to orgasm with fantasies; girls develop physically sooner than boys; may display shyness, blushing, and modesty.	Greater body competence (e.g., physical coordination); manual dexterity; growth patterns vary.
16-21 years	Uses formal logic (e.g., opposes racism); debates and can change sides of debate; understands probabilities; uses more flexible abstract thinking; examination of inner experiences; conflicts with parents begin to decrease.	Interest in relationships; solidifies personal identity; becomes goal directed; sometimes rebellious; increased concern for others; increased concern for future; places more importance on his/her role in life.	Identifies with moral principles, rules, and limit testing; experimentation with sex and drugs; examination of inner experiences.	Feelings of love and passion; development of more serious relationships; sense of sexual identity established1; increased capacity for tender and sensual love.	Heightened physical power, strength, coordination.

 

In using tools such as the preceding child development chart, keep in mind that:

·         There is a wide range of typical behavior, and at any particular age twenty-five percent of children will not have reached the behavior or skill, fifty percent will be showing it, and twenty-five percent will already have mastered it;

·         Some behaviors may be typical – in the sense of predictable – responses to trauma, including the trauma of separation as well as abuse and neglect;

·         Prenatal and postnatal influences may alter development;

·         Other factors, including culture, current trends, and values also influence what is defined as typical.

·         A parent needs to become aware of his/her own values, attitudes, and perceptions about what is typical in order to be more objective and culturally sensitive when assessing a child’s needs.  ™

 

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A Checklist for Growing Children

Here is an overview of what to expect children to do between birth and age 3.  If you believe your child seems different, call for a developmental evaluation.  Note:  Premature infants tend to develop more slowly.  Check with your doctor if you have questions.

 

At 3 months, does your child:

ü       turn head towards bright colors and lights

ü       move eyes in same direction together

ü       recognize bottle or breast

ü       respond to loud sounds

ü       make fist with both hands

ü       grasp rattles or hair

ü       wiggle and kick with legs and arms

ü       lift head and chest while on stomach

ü       smile

ü       make cooing sounds

 

At 6 months, does your child:

ü       follow moving object with eyes

ü       turn towards source of normal sound

ü       reach for objects to pick them up

ü       roll from stomach to back

ü       transfer objects from one hand to other

ü       play with toes

ü       help hold bottle during feeding

ü       recognize familiar faces

 

At 12 months, does your child:

ü       sit without support

ü       pull to standing position

ü       crawl on hands and knees

ü       drink from cup

ü       enjoy peek-a-boo and patty cake

ü       wave bye-bye

ü       hold out arms and legs while being dressed

ü       put objects into a container

ü       stack two blocks

ü       have a 5-6 work vocabulary

At 18 months, does your child:

ü       like to pull, push, and dump things

ü       follow simple directions (“bring the ball”)

ü       pull off shoes, socks, and mittens

ü       like to look at pictures

ü       feed self

ü       make marks on paper with crayons

ü       use 8-10 words that are understood

ü       walk without help

ü       step off low objects and keep balance

 

This checklist was originally printed in Early Intervention Services brochure for the Martin County Special Education Cooperative in Fairmont, Minnesota and developed by the Health and Welfare Region IV Infant Toddler Committee.

 

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General Developmental Sequence Toddler through Preschool ^[12]

This page presents typical activities and achievements for children from two to five years of age.  It is important to keep in mind that the time frames presented are averages and some children may achieve various developmental milestones earlier or later than the average but still be within the normal range.  This information is presented to help parents understand what to expect from their child.  Any questions you may have about your child’s development should be shared with his doctor or teacher.

 

Age 2	Physical	Social	Emotional	Intellectual
	ü       Walks well, goes up and down ü       Steps alone ü       Runs ü       Seats self on chair ü       Becoming independent in toileting ü       Uses spoon and fork ü       Imitates circular stoke ü       Turns pages singly, kicks ball ü       Attempts to dress self ü       Builds tower of six cubes	ü       Solitary play ü       Dependent on adult guidance ü       Plays with dolls ü       Refers to self by name ü       Socially very immature ü       Little concept of others as “people” ü       May respond to simple directions	ü       Very self-centered ü       Just beginning a sense of personal identity and belongings ü       Possessive often negative ü       Often frustrated no ability to choose between alternatives ü       Enjoys physical affection ü       Resistive to change ü       Becoming independent ü       More responsive to humor and distraction than discipline or reason	ü       Says words, phrases, and simple sentences ü       272 words ü       Understands simple directions ü       Identifies simple pictures ü       Likes to look at books ü       Short attention span ü       Avoids simple hazards ü       Can identify simple forms
Age 3	Physical	Social	Emotional	Intellectual
	ü       Runs well ü       Marches ü       Stands on one foot briefly ü       Rides tricycle ü       Imitates cross ü       Feeds self well ü       Puts on shoes and stockings ü       Unbuttons and buttons ü       Builds tower of 10 cubes ü       Pours from pitcher	ü       Parallel play ü       Enjoys being by others ü       Takes turns ü       Knows if he is a boy or girl ü       Enjoys brief group activities requiring no skill ü       Likes to “help” in small ways ü       Responds to verbal guidance	ü       Likes to conform ü       Easy going attitude ü       Not so resistive to change ü       More secure ü       Greater sense of personal identity ü       Beginning to be adventuresome ü       Enjoys music	ü       Says short sentences ü       896 words ü       Great growth in communication ü       Tells simple stories ü       Uses words as tools of thought ü       Wants to understand environment ü       Answers questions ü       Imaginative ü       May recite few nursery rhymes

 

Age 4	Physical	Social	Emotional	Intellectual
	ü       Skips on one foot ü       Draws “man” ü       Cuts with scissors (not well) ü       Can wash and dry face ü       Dress self except ties ü       Standing broad jump ü       Throws ball overhand ü       High motor drive	ü       Cooperative play ü       Enjoys other children’s company ü       Highly social ü       May play loosely organized group games – tag, duck-duck-goose, talkative, versatile	ü       Seems sure of himself ü       Out-of-bounds behavior ü       Often negative ü       May be defiant ü       Seems to be testing himself out ü       Needs controlled freedom	ü       Uses complete sentences ü       1,540 words ü       Asks endless questions ü       Learning to generalize ü       Highly imaginative ü       Dramatic ü       Can draw recognizable simple objects

 

Age 5	Physical	Social	Emotional	Intellectual
	ü       Hops and skips ü       Dresses without help ü       Good balance and smoother muscle action ü       Skates ü       Rides wagon and scooter ü       Prints simple letters ü       Handedness established ü       Ties shoes ü       Girls small muscle development about 1 year ahead of boys	ü       Highly cooperative play ü       Has special “friends” ü       Highly organized ü       Enjoys simple table games requiring turns and observing rules ü       “School” ü       Feels pride in clothes and accomplishments ü       Eager to carry out some responsibility	ü       Self-assured ü       Stable ü       Well-adjusted ü       Home-centered ü       Likes to associate with mother ü       Capable of some self-criticism ü       Enjoys responsibility ü       Likes to follow the rules	ü       2,072 words ü       Tells long tales ü       Carries out directions well ü       Reads own name ü       Counts to 10 ü       Asks meaning of words ü       Knows colors ü       Beginning to know difference between fact and fiction-lying ü       Interested in environment, city, stores, etc

 

 

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Healthy Minds: Nurturing Your Child’s Development from 0 to 2 Months

What do we really know about how a young child develops?  What can parents do to best support their child’s healthy development and growing brain?  Some of the answers are in this series of Healthy Minds handouts.  Each handout is based on findings from a report [13] from the national Academy of Sciences that examined the research on child and brain development to establish what is known about the early years.  The information we offer is age-specific, summarizes key findings from the report and suggest how you might be able to use these key findings to nurture your own child’s healthy development.

Key Findings from the report include:

·         Your relationship with your child is the foundation of his or her healthy development.

·         Your child’s development depends on both the traits he or she was born with (nature), and what he or she experiences (nurture).

·         All areas of development (social/emotional/intellectual/language/motor) are linked.  Each depends on, and influences, the others.

·         What children experience, including how their parents respond to them, shapes their development as they adapt to the world.

How it looks in everyday family life:

When 2-month-old Benjamin cries and cries each evening and kicks his arms and legs wildly, his parents try everything they can think of to comfort him.  They rock, walk and swaddle him, massage his tummy in case he has gas and sing lullabies, all to calm him down.  Sometimes it takes 20 minutes; sometimes it takes 2 hours.

Benjamin’s crying, and his parents’ response to it, shows how all areas of his development are linked, and how his parents help to encourage his development.  Benjamin cries because he has come to expect that his parents will respond.  When mom and dad don’t give up trying to comfort Benjamin no matter how frustrating it can be they are nurturing his social and emotional development because it makes him feel important and he learns to trust that his parents will care for him.  This gives him the confidence to trust others, which will help him form healthy relationships as he grows.  In addition, being soothed by his parents in these early months will help him learn to soothe himself as he gets older, a very important skill throughout life.  Using his voice and body to communicate is part of Benjamin’s early language and motor development.  When his parents answer his cries, he learns that his efforts at communicating are successful, which encourages him to communicate more, first through gestures and sounds, and later through words.

Relationships are the foundation of a child’s healthy development.

Charting Your Child’s Healthy Development: 0 to 2 months

The following chart describes many of the things your baby is learning between 0 and 2 months and what you can do to support your child in all areas of his development.  As you read, remember that children develop at their own pace and in their own way.  Understanding who your child is, what his strengths are and where he needs more support, is essential for promoting his healthy development.  If you have questions regarding your child’s development, ask you pediatrician.

What’s going on:	What you can do:	Question to ask yourself:
One of the most important tasks of the first 2 months is to help newborns feel comfortable in their new world. They are learning to regulate their eating and sleeping patterns and their emotions, which help them feel content, safe and secure.	lObserve carefully. This will help you figure out what your baby’s cries are telling you. lSoothe your baby. When you respond to your baby’s cries and meet his needs, you let him know he is loved. You can’t spoil a baby. In fact, by responding lovingly to his needs, you are helping him learn skills now that allow him eventually to soothe himself. You are also promoting a strong bond and healthy brain development.	lWhat soothes your baby? How do you know? lWhat most distresses him?
Newborns use their gestures (body movements), sounds and facial expressions to communi­cate their feelings and needs from day to day. They use different cries to let you know they are hungry, tired or bored. They ask for a break by looking away, arching their backs, frowning or crying. They socialize with you by watching your face and ex­changing looks.	lFigure out what your baby is trying to tell you. Responding makes him feel important and tells him he is a good commu­nica­tor. This builds a positive sense of self and a desire to communicate more. lTalk and sing to your baby. Tell him about everything that’s going on around him. Pay attention to the sights and sounds he likes. Find toys and everyday objects with different colors and textures and see which he likes best.	lHow does your baby communicate with you? lWhat kinds of interactions does he like best? How do you know? lHow does he let you know when he has had enough?
Even as newborns, babies can play in many ways. They can connect sounds with their sources, and love when you talk and sing to them. Play helps ba­bies learn about the world around them. It is also an important way they connect with you, helping them to develop a strong attach­ment and promoting healthy so­cial development.	lOffer your baby lots of different objects for him to look at, touch and even grip in his palms. He can focus best on things that are 8 to 12 inches away. lPlay “tracking” games by moving yourself and interesting objects back and forth. First he will use his eyes to follow. Eventually he will move his head from side to side. This helps strengthen his neck muscles as well as exercise his visual abilities.	lWhat experiences does your baby seem to like best? (For example, talking with him; looking at toys or other objects; hearing the cat “meow.”) lWhat kinds of toys grab your baby’s attention? How does he let you know what he’s interested in? lWhat kind of play do you enjoy most with your baby?

These handouts are brought to you by ZERO TO THREE, the nation’s leading resource on the first 3 years of life, and the American Academy of Pediatrics, dedicated to the health of all children. –

 

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Healthy Minds: Nurturing Your Child’s Development from 2 to 6 Months

What do we really know about how a young child develops?  What can parents do to best support their child’s healthy development and growing brain?  Some of the answers are in this series of Healthy Minds handouts.  Each handout is based on findings from a report [14] from the national Academy of Sciences that examined the research on child and brain development to establish what is known about the early years.  The information we offer is age-specific, summarizes key findings from the report and suggest how you might be able to use these key findings to nurture your own child’s healthy development.

Key Findings from the report include:

·         Your relationship with your child is the foundation of his or her healthy development.

·         Your child’s development depends on both the traits he or she was born with (nature), and what he or she experiences (nurture).

·         All areas of development (social/emotional/intellectual/language/motor) are linked.  Each depends on, and influences, the others.

·         What children experience, including how their parents respond to them, shapes their development as they adapt to the world.

How it looks in everyday family life:

Five-month-old Tara loves playing peek-a-boo with her mom and dad. When they stop, she squeals and reaches out her arms to let them know she wants more. So they continue. Soon her parents add another twist to the game as they start to hide behind the pillow for a few seconds before the “reappear” to give her time to anticipate what will happen next.

This simple game is more than just fun. It shows how all areas of Tara’s development are linked and how her parents help to encourage her healthy development. Tara’s interest in playing with her parents is a sign of her social and emotional development because she has fun with her parents and can see how much they enjoy being with her. This makes her feel loved and secure, and will help her develop other positive relationships as she grows. Her desire to play this game with mom and dad leads to the development of new intellectual abilities as she learns to anticipate what comes next, an important skill for helping her feel more in control of her world. Knowing what to expect will also help her to more easily deal with being separated from her parents as she learns that people exist even when she can’t see them.

Tara’s early language and motor abilities emerge as she squeals, makes sounds and moves her arms to let her parents know that she does not want them to stop. When they continue, her parents let her know that she is a good communicator, and each time they reappear, she learns that she can trust them to always come back.

Relationships are the foundation of a child’s healthy development.

Charting Your Child’s Healthy Development: 2 to 6 months

The following chart describes many of the things your baby is learning between 2 and 6 months and what you can do to support your child in all areas of his development. As you read, remember that children develop at their own pace and in their own way. Understanding who your child is, what his strengths are and where he needs more support, is essential for promoting his healthy development. If you have questions regarding your child’s development, ask your pediatrician.

What’s going on:	What you can do:	Question to ask yourself:
Babies are very interactive at this age. They use their new language and communication skills as they smile and coo back and forth, and enjoy babbling, starting with “ohs” and “ahs” and progress to P’s, M’s, B’s and D’s. Your baby may babble and then pause, waiting for you to respond. They also love to imitate, which helps them learn new skills. For example, mom sticks out her tongue, baby imitates and mom does it again. This teaches them about the back and forth conversation.	lWhen your baby babbles, both talk and babble back, as if you both understand every word. These early conversations will teach her hundreds of words before she can actually speak any of them. lEngage in back-and-forth interactions with gestures. For example, hold out an interesting object, encourage your baby to reach for it and then signal her to give it back. Keep this going as long as your baby seems to enjoy it.	lHow does your baby let you know what she wants and how she’s feeling? lHow do you and your baby enjoy communicating with each other? What do you say or do that gets the biggest reaction from her?
Babies this age love to explore. They learn from looking at, holding and putting their mouths on different objects. At about 3 months, babies begin to reach for things and try to hold them. Make sure all objects are safe. A toy or anything else you give her shouldn’t fit entirely in her mouth.	lIntroduce one toy at a time so your baby can focus on, and explore, each one. Good choices include a small rattle with a handle, a rubber ring, a soft doll and a board book with pictures. lLay your baby on her back and hold brightly colored toys over her chest within her reach. She’ll love reaching up and pulling them close. You will start to see what most interests her.	lWhat kind of toys orobjects does your baby seem most interested in? How do you know? lHow do you and your baby most enjoy playing together? Why?
Babies have greater control over their bodies. By 4 to 6 months, they may be able to roll both ways, become better at reaching and grasping and will begin to sit with assistance. They also begin wanting to explore their food and help feed themselves. Touching and tasting different foods is good for learning and for building self-confidence.	lPlace your baby in different positions-on her back, stomach, and sitting with support. Each gives her a different view and a chance to move and explore in different ways. lLet your baby play with your fingers and explore the bottle or breast during feedings. As she grows, let her handle finger foods and help hold the spoon.	lHow does your baby use her body to explore? Which positions does she like the best and least? lHow would you describe your baby’s activity level? Does she like/need to move around a lot or is she more laid-back?

These handouts are brought to you by ZERO TO THREE, the nation’s leading resource on the first 3 years of life, and the American Academy of Pediatrics, dedicated to the health of all children. –

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The Effects of Children’s Developmental Level on their Experience During Separation and Placement

Infancy (Birth to 18 months)

Cognitive Development

·         Infants have not developed object permanence.

·         Infants have short attention spans and memory.

·         They do not understand change, they only feel it.

·         Changes and unfamiliar sensory experiences frighten them.

·         They have little or no language ability and, therefore, cannot communicate, except by crying.

Emotional Development

·         Infants are emotionally dependent upon others to meet their basic needs.

·         Infants generally form strong attachments to their primary caregiver and often cannot be comforted by others when distressed.

·         After five to six months of age, infants display anxiety in the presence of unknown persons.

·         Emotional stability depends upon continuity and stability in the environment and the continued presence of the primary caregiver.

Social Development

·         Infants have few ways to communicate their needs.  If adults do not recognize their distress, their needs may remain unmet.

·         Social attachments are limited to immediate caregivers and family members.

·         Infants do not easily engage in relationships with unfamiliar persons.

Implications for Separation and Placement

·         Infants’ cognitive limitations greatly increase their experience of stress.  Infants will be extremely distressed by changes in the environment and caregivers.

·         Infants have few internal coping skills.  Adults must “cope” for them.

·         Infants experience the absence of caregivers as immediate, total, and complete.  Infants do not generally turn to others for help and support.

·         Separation during the first year can interfere with the development of trust.

·         Infants’ distress will be lessened if their new environment can be made consistent with the old one, and if the birth parent(s) can visit regularly.

Preschool (Two to Five Years)

Cognitive Development

·         Child has limited vocabulary, does not understand complex words or concepts.

·         Child does not have a well-developed understanding of time.

·         Child has difficulty understanding cause and effect and how events relate.

·         Child may display magical thinking and fantasy to explain events.

·         Child displays egocentric thinking: The world is as he views it.  He doesn’t understand other’s perspectives.

·         The child may not generalize experience from one situation to another.

Emotional Development

·         The child is still dependent on adults to meet his emotional and physical needs.  The loss of adult support leaves him feeling alone, vulnerable, and anxious.

·         Development of autonomy and a need for self-assertion and control make it extremely difficult for a child this age to have things “done to him” by others.

Social Development

·         The child is beginning to relate to peers in reciprocal, cooperative, and interactive play.

·         The child relates to adults in playful ways and is capable of forming attachments with adults other than parents.

·         “Good” and “bad” acts are defined by their immediate, personal consequences.  Children who are bad are punished; children who are good are rewarded.

Implications for Separation and Placement

·         The child needs dependable adults to help him cope.  Child can turn to substitute caregivers or a known and trusted caseworker for help and support during the placement process.

·         The preschool child is likely to have an inaccurate and distorted perception of the placement experience.

·         Any placement of more than a few weeks is experienced as permanent.  Without visitation, the child may assume parents to be gone and not coming back.

·         The child will often view separation and placement as a punishment for “bad” behavior and will cling to his own explanation for the placement.  Self-blame increases anxiety and lowers self-esteem.

·         Because the child cannot generalize experiences from one situation to another, all new situations are unknown and, therefore, more threatening.

·         The child will display considerable anxiety about the new home.

·         Most often, while verbal reassurances are helpful, the child needs to experience the environment to feel comfortable in it.

·         Forced placement, without proper preparation, may generate feelings of helplessness and loss of control, which may interfere with the development of autonomous behavior.

School Age (Six to Nine Years)

Cognitive Development

·         The child has developed concrete operations and better understands cause and effect.

·         The child has limited perspective-taking ability.  She is beginning to understand that things happen to her that are not her fault.

·         The world is experienced in concrete terms.  The child is most comfortable if her environment is structured and she understands the rules.

·         The child has a better perspective regarding time; she can differentiate days and weeks, but cannot fully comprehend months or years.

Emotional Development

·         Self-esteem is strongly affected by how well she does things in her daily activities, including academic performance and play activities.

·         She is anxious when she does not have structure and when she does not understand the “rules” or expectations of a new situation.

·         The child’s primary identification is with her family and her self-esteem is tied to people’s perception of her family’s worth.

Social Development

·         The child can form significant attachments to adults and to peers.

·         The child derives security from belonging to a same-sex social group.

·         The child recognizes that being a foster child is somehow “different” from the other children.

·         The child is fiercely loyal and exclusive in her relationships.

·         The child’s value system has developed to include “right” and “wrong,” and she experiences guilt when she has done something wrong.

 

 

Implications for Separation and Placement

·         The child can develop new attachments and turn to adults to meet her needs, which increases her ability to cope in stressful situations.

·         The child’s perception of the reason for the separation may be distorted.  In her concrete world, someone must be blamed, including caseworker, foster caregiver, agency, or herself.

·         The child will compare foster caregivers to her parents, and the caregivers will lose.

·         The loss of her peer group and friends may be almost as traumatic as the loss of her parents.  Making new friends may be difficult.  The child may be embarrassed and self-conscious about her “foster child” status, and she may feel isolated.

·         The child will be very confused if the “rules” and expectations in the foster home are different from what she is used to.

·         The child has a better understanding of time.  Placements of a few months can be tolerated, if the child understands she is eventually to go home.  Longer placements may be experienced as permanent.

·         If the child was placed after some perceived misbehavior, she may feel responsible and guilty, and anxious about her parents accepting her back.

Preadolescence (Ten to Twelve Years)

Cognitive Development

·         Some preadolescent children are beginning to think and reason abstractly, and to recognize complex causes of events.

·         The child is able to understand perspectives other than his own.  Some children have developed insight and may recognize that their parents have problems that contributed to the need for placement.

·         The child’s time perspective is more realistic.

·         The child can generalize experiences from one setting to another.

·         The child understands that rules often change depending upon the situation.  The child can more easily adapt his behavior to meet the expectations of different situations.

Emotional Development

·         Self-esteem and identity are still largely tied to the family.  Negative comments regarding the family reflect upon him as well.

·         The child has increased ability to cope independently for short periods of time.  He still turns to significant adults for approval, support, and reassurance when things are difficult.

·         He may be very embarrassed by and self-conscious about his foster child status.

Social Development

·         The child’s social world has expanded to include many people outside the family.

·         Peers are extremely important.  Most peer relationships are of the same sex.

·         Opposite sex friendships exist, but unless the child has been prematurely introduced to sexuality, these are of not special interest or concern.

·         The child still needs trusted adults for leadership, support, nurturance, and approval.

·         The child can begin to understand that his parents have the capacity to do wrong.

Implications for Separation and Placement

·         The child has an increased ability to understand the reasons for the separation.  With help, the child may be able to develop a realistic perception of the situation and avoid unnecessary self-blame.

·         The child can benefit from supportive adult intervention, such as casework counseling, to help sort through his feelings about the situation.

·         If given permission, the child may be able to establish relationships with caregivers without feeling disloyal to his parents.

·         The child may be embarrassed and self-conscious regarding his family’s problems and his foster care status, which may contribute to low self-esteem.

·         The child may be worried about his family as a unit and may demonstrate considerable concern for siblings and parents.

·         It may be difficult to replace “best friends” in the foster care setting.  The child may be lonely and isolated.

Early Adolescence (Thirteen to Fourteen)

Cognitive Development

·         The child’s emerging ability to think abstractly may make complicated explanation of reasons for placement more plausible.

·         The child may have an increased ability to identify her own feelings and to communicate her concerns and distress verbally.

Emotional Development

·         Preadolescence is the time of emotional “ups and downs.”  The child may experience daily (or hourly) mood swings and fluctuations.

·         Physical and hormonal changes, including significant and rapid body changes, generate a beginning awareness of sexuality.  The child experiences many new feelings, some of which are conflictual and contradictory.

·         The child begins to desire “independence” by rejecting parental values and rules, and adopting the values of her peers express independence.

·         The child experiences anxiety when deprived of structure, support, and rules.

Social Development

·         The child may be embarrassed to admit her need for adult approval.

·         The child is status conscious.  Much of the child’s self-esteem is derived from peer group acceptance and from being in the “right” peer group.

·         The child may need to keep up appearances and defend her family to others.

·         The child is becoming aware of social roles, and experiments with different roles and behaviors.

·         Although many children will have developed a moral attitude with clearly defined “rights” and “wrongs;”values of the peer group often supersede their own.

Implications for Separation and Placement

·         Early adolescence is an emotionally chaotic period.  Any additional stress has the potential of creating “stress overload” and may precipitate crisis.

·         The child may resist relationships with adults.  Dependence upon adults threatens her “independence.”  By rejecting adults, the child deprives herself of an important source of coping support.

·         The child may deny much of her discomfort and pain, which prevents her from constructively coping with those feelings.

·         Separation from parents, especially if the result of family conflict and unruly behavior on the part of child, may generate guilt and anxiety.

·         Identity is an emerging issue; dealing with her parents’ shortcomings is difficult.  Parents may be idealized, shortcomings may be denied, or they may be verbally criticized and rejected.

·         Entry into sexual relationships may be very frightening without the support of a consistent, understanding adult.

·         The child has the capacity to participate in planning and to make suggestions regarding her own life.

·         Persistent, repeated attempts to engage the child by a caseworker can have very positive results.  The child may greatly benefit from the support and guidance of the worker.

Middle Adolescence (Fifteen to Seventeen)

Cognitive Development

·         The child has the cognitive ability to understand complex reasons for separation, placement, and family behavior.

·         The ability to be self-aware and insightful may be of help in coping with the situation and his conflicting feelings about it.

·         The child is more able to think hypothetically.  He can use this ability to plan for future and to consider potential outcomes of different strategies.

Emotional Development

·         The child is developing greater self-reliance.  He is more able to independently make, or contribute to making, many decisions about his life and activities.

·         The development of positive self-esteem is as dependent upon acceptance by peers of the opposite sex as it is on being accepted by same-sex peers.

·         Identity is being formulated.  Many behaviors and ways of dealing with situations are tried, and adopted or discarded in an attempt to determine what feels right for him.

Social Development

·         Opposite-sex relationships are as important as same-sex relationships.  Individual relationships are becoming more important.

·         The child is very interested in adults as role models.

·         The child is beginning to focus on future planning and emancipation.

·         Toward the end of middle adolescence, many children may begin to question previously held beliefs and ideas regarding “right” and “wrong,” and they may be less influenced by peer attitudes.  An emergence of independent ethical thinking may be evident.

Implications for Separation and Placement

·         The child will probably experience ambivalence about his family.  With help and reassurance that ambivalence is normal, the child may be able to accept his feelings and be able to be angry at and love his family at the same time.

·         The child’s need for independence may affect his response to placement in a family setting.  He may be unwilling to accept the substitute family as more than a place to stay.  This may be perceived as the child’s failure to “adjust” to the placement, even though it is a healthy and expected response.

·         The child may not remain in a placement if it does not meet his needs.

·         The child may constructively use casework counseling to deal with the conflicts of separation and placement in a way that meets the child’s needs without threatening his self-esteem and independence.   –

 

The Institute for Human Services.  1990. Reprinted with permission.

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Effects of Abuse and Neglect on Development

Neglect might affect a child’s development in the following ways:

·         Children who are neglected in regard to supervision may harm themselves and as a result may learn not to take risks. This can delay development.

·         Children need caregivers to guide and direct their developmental learning. A child left alone cannot model or mimic skills and may not receive the needed help.

·         Children in a deprived environment may not receive needed stimulation. Children need objects to play with and things to watch and observe.

·         Basic needs must be met before children can concern themselves with other developmental tasks. If children are hungry, sick, or craving emotional attention, they cannot attend to other skills or learning.

Physical abuse might affect a child’s development in the following ways:

·         A child who is physically abused may be afraid to take risks for fear of doing something wrong, and development may be delayed.

·         Some children sustain serious injuries that affect their development on an ongoing basis such as hearing loss, blindness, or brain injuries.

Sexual abuse might affect development in the following ways:

·         Sexual abuse may introduce sexual activity before a child is physically mature. This may cause physical injury that impedes the child’s normal sexual development.

·         Sexually transmitted diseases and infections may impede the child’s normal sexual development.

·         The emotional trauma of sexual abuse may impede normal sexual development--- contributing to promiscuous behavior or a fear of sexuality.

·         The emotional trauma of sexual abuse may take tremendous energy and focus that would otherwise be devoted to age appropriate developmental tasks. For example, how does an eleven year old who has been sexually abused by her two uncles sit around and giggle with her girlfriend about “cute boys” in her class?

Emotional maltreatment might impact development in the following areas:

·         Emotional maltreatment may cause self-esteem to erode to the point where the child feels incompetent to tackle even the most basic skills.

·         Emotional maltreatment that keeps a child from developing outside relationships can result in poor social development, lack of social skills, and difficulty with peers etc.

™

The Institute for Human Services.  1990. Reprinted with permission.

 

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Bonding And Attachment In Maltreated Children

Consequences of Emotional Neglect in Childhood

By Bruce D. Perry, M.D., Ph.D.

Introduction

The most important property of humankind is the capacity to form and maintain relationships. These relationships are absolutely necessary for any of us to survive, learn, work, love and procreate. Human relationships take many forms but the most intense, most pleasurable and most painful are those relationships with family, friends and loved ones. Within this inner circle of intimate relationships, we are bonded to each other with “emotional glue” -  bonded with love.

Each individual’s ability to form and maintain relationships using this “emotional glue” is different. Some people seem “naturally” capable of loving. They form numerous intimate and caring relationships and, in doing so, get pleasure. Others are not so lucky. They feel no “pull” to form intimate relationships, find little pleasure in being with or close to others. They have few, if any friends and more distant, less emotional glue with family. In extreme cases an individual may have no intact emotional bond to any other person. They are self-absorbed, aloof or may even present with classic neuropsychiatric signs of being schizoid or autistic.

The capacity and desire to form emotional relationships is related to the organization and functioning of specific parts of the human brain. Just as the brain allows us to see, smell, taste, think, talk and move, it is the organ that allows us to love - or not. The systems in the human brain that allow us to form and maintain emotional relationships develop during infancy and the first years of life. Experiences during this early vulnerable period of life are critical to shaping the capacity to form intimate and emotionally healthy relationships. Empathy, caring, sharing, inhibition of aggression, capacity to love and a host of other characteristics of a healthy, happy and productive person are related to the core attachment capabilities which are formed in infancy and early childhood.

Frequently Asked Questions

What is attachment?

Well, it depends. The word attachment is used frequently by mental health, child development and child protection workers but it has slightly different meanings in these different contexts. The first thing to know is that we humans create many kinds of “bonds.” A bond is a connection between one person and another. In the field of infant development, attachment refers to a special bond characterized by the unique qualities of maternal-infant or primary caregiver-infant relationships. The attachment bond has several key elements: (1) an attachment bond is an enduring emotional relationship with a specific person; (2) the relationship brings safety, comfort and pleasure; (3) loss or threat of loss of the person evokes intense distress. This special form of relationship is best characterized by the maternal-child relationship.  As we study the nature of these special relationships, we are finding out about how important they can be for future development of the child.  Indeed, many researchers and clinicians feel that the maternal-child attachment provides the working framework for all subsequent relationships that the child will develop. A solid and healthy attachment with a primary caregiver appears to be associated with a high probability of healthy relationships with others, while poor attachment with the mother or primary caregiver appears to be associated with a host of emotional and behavioral problems later in life.

In the mental health field, attachment has come to reflect the global capacity to form relationships. For the purposes of this paper, attachment capabilities refers to the capacity to form and maintain an emotional relationship while attachment refers to the nature and quality of the actual relationship. A child, for example, may have an “insecure” attachment or “secure” attachment.

What is bonding?

Simply stated, bonding is the process of forming an attachment. Just as bonding is the term used when gluing one object to another, bonding is using our “emotional glue” to become connected to another. Bonding, therefore, involves a set of behaviors that will help lead to an emotional connection (attachment).

Are bonding and attachment genetic?

The biological capacity to bond and form attachments is most certainly genetically determined.  The drive to survive is basic in all species.  Infants are defenseless and must depend upon a caregiving adult for survival.  It is in the context of this primary dependence, and the maternal response to this dependence, that a relationship develops.  This attachment is crucial for survival.

An emotionally and physically healthy mother will be drawn to her infant – she will feel a physical longing to smell, cuddle, rock, coo and gaze at her infant.  In turn the infant will respond with snuggling, babbling, smiling, sucking and clinging.  In most cases, the mother’s behaviors bring pleasure, and nourishment to the infant, and the infant’s behaviors bring pleasure and satisfaction to the mother.  This reciprocal positive feedback loop, this maternal-infant dance, is where attachment develops.

Therefore, despite the genetic potential for bonding and attachment, it is the nature, quantity, pattern and intensity of early life experiences that express that genetic potential.  Without predictable, responsive, nurturing and sensory-enriched caregiving, the infant’s potential for normal bonding and attachments will be unrealized.  The brain systems responsible for healthy emotional relationships will not develop in an optimal way without the right kinds of experiences at the right times in life.

What are bonding experiences?

The acts of holding, rocking, singing, feeding, gazing, kissing and other nurturing behaviors involved in caring for infants and young children are bonding experiences. Factors crucial to bonding include time together (in childhood, quantity does matter!), face-to-face interactions, eye contact, physical proximity, touch, and other primary sensory experiences such as smell, sound, and taste. Scientists believe the most important factor in creating attachment is positive physical contact (e.g., hugging, holding, and rocking). It should be no surprise that holding, gazing, smiling, kissing, singing, and laughing all cause specific neurochemical activities in the brain. These neurochemical activities lead to normal organization of brain systems that are responsible for attachment.

The most important relationship in a child’s life is the attachment to his or her primary caregiver, optimally, the mother.  This is due to the fact that this first relationship determines the biological and emotional ‘template’ for all future relationships.  Healthy attachment to the mother built by repetitive bonding experiences during infancy provides the solid foundation for future healthy relationships.  In contrast, problems with bonding and attachment can lead to a fragile biological and emotional foundation for future relationships.

When are these windows of opportunity?

Timing is everything.   Bonding experiences lead to healthy attachments and healthy attachment capabilities when they are provided in the earliest years of life.  During the first three years of life, the human brain develops to 90 percent of adult size and puts in place the majority of systems and structures that will be responsible for all future emotional, behavioral, social and physiological functioning during the rest of life.  There are critical periods during which bonding experiences must be present for the brain systems responsible for attachment to develop normally.  These critical periods appear to be in the first year of life, and are related to the capacity of the infant and caregiver to develop a positive interactive relationship.

What happens if this window of opportunity is missed?

The impact of impaired bonding in early childhood varies. With severe emotional neglect in early childhood the impact can be devastating. Children without touch, stimulation and nurturing can literally lose the capacity to form any meaningful relationships for the rest of their lives.

Fortunately most children do not suffer this degree of severe neglect. There are, however, many millions of children who have some degree of impaired bonding and attachment during early childhood. The problems that result from this can range from mild interpersonal discomfort to profound social and emotional problems. In general, the severity of problems is related to how early in life, how prolonged, and how severe the emotional neglect has been.

This does not mean that children with these experiences have no hope to develop normal relationships. Very little is known about the ability of replacement experiences later in life to “replace” or repair the undeveloped or poorly organized bonding and attachment capabilities. Clinical experiences and a number of studies suggest that improvement can take place, but it is a long, difficult, and frustrating process for families and children. It may take many years of hard work to help repair the damage from only a few months of neglect in infancy.

Are there ways to classify attachment?

Like traits such as height or weight, individual attachment capabilities are continuous. In an attempt to study this range of attachments, however, researchers have clustered the continuum into four categories of attachment: secure, insecure-resistant, insecure-avoidant, and insecure-disorganized/disoriented.  Securely attached children feel a consistent, responsive, and supportive relation to their mothers even during times of significant stress.  Insecurely attached children feel inconsistent, punishing, unresponsive emotions from their caregivers and feel threatened during times of stress.

Classification of Attachment	Percentage at One-Year	Response in Strange Situation
Securely attached	60-70 %	Explores with M in room; upset with separation; warm greeting upon return; seeks physical touch and comfort upon reunion
Insecure: avoidant	15-20 %	Ignores M when present; little distress on separation; actively turns away from M upon reunion
Insecure: resistant	10-15 %	Little exploration with M in room, stays close to M; very distressed upon separation; ambivalent or angry and resists physical contact upon reunion with M
Insecure: disorganized/ disoriented	5-10 %	Confusion about approaching or avoiding M; most distressed by separation; upon reunion acts confused and dazed — similar to approach-avoidance confusion in animal models

Dr. Mary Ainsworth developed a simple process to examine the nature of a child’s attachment. This is called the Strange Situation procedure. Simply stated, the mother and infant are observed in a sequence of “situations:” parent-child alone in a playroom; stranger entering room; parent leaving while the stranger stays and tries to comfort the baby; parent returns and comforts infant; stranger leaves; mother leaves infant all alone; stranger enters to comfort infant; parent returns and tries to comfort and engage the infant. The behaviors during each of these situations is observed and “rated.” The behavior of children in this testing paradigm is observed and categorized based upon both the child’s willingness to re-engage with the parent, and the child’s emotional state during the reunion.

What other factors influence bonding and attachment?

Any factors that interfere with bonding experiences can interfere with the development of attachment capabilities. When the interactive, reciprocal “dance” between the caregiver and infant is disrupted or difficult, bonding experiences are difficult to maintain. Disruptions can occur because of primary problems with the infant, the caregiver, the environment or the fit between the infant and caregiver.

Infant: The child’s “personality” or temperament influences bonding. If an infant is difficult to comfort, irritable or unresponsive compared to a calm, self-comforting child, he or she will have more difficulty developing a secure attachment. The infant’s ability to participate in the maternal-infant interaction may be compromised due to a medical condition such as pre-maturity, birth defect, or illness.

Caregiver:  The caregiver’s behaviors can also impair bonding. Critical, rejecting, and interfering parents tend to have children that avoid emotional intimacy. Abusive parents tend to have children that become uncomfortable with intimacy and withdraw. The child’s mother may be unresponsive to the child due to maternal depression, substance abuse, overwhelming personal problems, or other factors that interfere with her ability to be consistent and nurturing for the child.

Environment:  A major impediment to healthy attachment is fear. If an infant is distressed due to pain, pervasive threat, or a chaotic environment, they will have a difficult time participating in even a supportive caregiving relationship. Infants or children in domestic violence, refugee situations, community violence, or war zone environments are vulnerable to developing attachment problems.

Fit:  The “fit” between the temperament and capabilities of the infant and the mother is crucial.  Some caregivers can be just fine with a calm infant, but are overwhelmed by an irritable infant.  The process of reading each other’s non-verbal cues and responding appropriately is essential to maintain the bonding experiences that build in healthy attachments.  Sometimes a style of communication and response familiar to a mother from one of her other children may not fit her new infant.  The mutual frustration of being “out of sync” can impair bonding.

How does abuse and neglect influence attachment?

There are three primary themes that have been observed in abusive and neglectful families. The most common effect is that maltreated children are, essentially, rejected. Children who are rejected by their parents will have a host of problems (see below) including difficulty developing emotional intimacy. In abusive families, it is common for this rejection and abuse to be transgenerational. The neglectful parent was neglected as a child; they pass on the way they were parented. Another theme is “parentification” of the child. This takes many forms. One common form is when a young immature woman becomes a single parent. The infant is treated like a playmate and very early in life like a friend. It is common to hear these young mothers talk about their four-year-old as “my best friend” or “my little man.” In other cases, the adults are so immature and uninformed about children that they treat their children like adults - or even like another parent. As a result, their children may participate in fewer activities with other children who are “immature.” This false sense of maturity in children often interferes with the development of same-aged friendships. The third common theme is the transgenerational nature of attachment problems - they pass from generation to generation.

It is important to note that previously secure attachments can change suddenly following abuse and neglect. The child’s perception of a consistent and nurturing world may no longer “fit” with their reality. For example, a child’s positive views of adults may change following physical abuse by a baby-sitter.

Are attachment problems always from abuse?

No, in fact the majority of attachment problems are likely due to parental ignorance about development rather than abuse. Many parents have not been educated about the critical nature of the experiences of the first three years of life. With more public education and policy support for these areas, this will improve. Currently, this ignorance is so widespread that it is estimated that 1 in 3 people has an avoidant, ambivalent, or resistant attachment with their caregiver. Despite this insecure attachment, these individuals can form and maintain relationships - yet not with the ease that others can.

What specific problems can I expect to see in maltreated children with attachment problems?

The specific problems that you may see will vary depending upon the nature, intensity, duration and timing of the neglect and abuse. Some children will have profound and obvious problems and some will have very subtle problems that you may not realize are related to early life neglect. Sometimes these children do not appear affected by their experiences. However, it is important to remember why you are working with the children and that they have been exposed to terrible things. There are some clues that experienced clinicians consider when working with these children.

Developmental delays: Children experiencing emotional neglect in early childhood often have developmental delay in other domains. The bond between the young child and caregivers provides the major vehicle for developing physically, emotionally and cognitively. It is in this primary context that children learn language, social behaviors, and a host of other key behaviors required for healthy development. Lack of consistent and enriched experiences in early childhood can result in delays in motor, language, social and cognitive development.

Eating: Odd eating behaviors are common, especially in children with severe neglect and attachment problems. They will hoard food, hide food in their rooms, eat as if there will be no more meals even if they have had years of consistent available foods. They may have failure to thrive, rumination (throwing up food), swallowing problems and, later in life, odd eating behaviors that are often misdiagnosed as anorexia nervosa.

Soothing behavior: These children will use very primitive, immature and bizarre soothing behaviors. They may bite themselves, head bang, rock, chant, scratch or cut themselves. These symptoms will increase during times of distress or threat.

Emotional functioning: A range of emotional problems is common in these children including depressive and anxiety symptoms. One common behavior is “indiscriminant” attachment. All children seek safety. Keeping in mind that attachment is important for survival, children may seek attachments- any attachments- for their safety. Non-clinicians may notice abused and neglected children are “loving” and hug virtual strangers. Children do not develop a deep emotional bond with relatively unknown people; rather, these “affectionate” behaviors are actually safety seeking behaviors. Clinicians are concerned because these behaviors contribute to the abused child’s confusion about intimacy and are not consistent with normal social interactions.

Inappropriate modeling: Children model adult behavior - even if it is abusive. They learn abusive behavior is the “right” way to interact with others. As you can see, this potentially causes problems in their social interactions with adults and other children. For children that have been sexually abused, they may become more at-risk for future victimization. Males that have been sexually abused may become sexual offenders.

Aggression: One of the major problems with these children is aggression and cruelty. This is related to two primary problems in neglected children: (1) lack of empathy and (2) poor impulse control. The ability to emotionally “understand” the impact of your behavior on others is impaired in these children. They really do not understand or feel what it is like for others when they do or say something hurtful. Indeed, these children often feel compelled to lash out and hurt others, most typically something less powerful than they are. They will hurt animals, smaller children, peers and siblings. One of the most disturbing elements of this aggression is that it is often accompanied by a detached, cold lack of empathy. They may show regret (an intellectual response) but not remorse (an emotional response) when confronted about their aggressive or cruel behaviors.

What Can I Do To Help?

Parents and caregivers make all the difference in the lives of maltreated children. This section suggests a few different ways to help.

Nurture these children: These children need to be held and rocked and cuddled. Be physical, caring and loving to children with attachment problems. Be aware that for many of these children, touch in the past has been associated with pain, torture or sexual abuse. In these cases, make sure you carefully monitor how they respond- be “attuned” to their responses to your nurturing and act accordingly. In many ways, you are providing replacement experiences that should have taken place during their infancy- but you are doing this when their brains are harder to modify and change. Therefore they will need even more bonding experiences to help develop attachments.

Try to understand the behaviors before punishment or consequences: The more you can learn about attachment problems, bonding, normal development and abnormal development, the more you will be able to develop useful behavioral and social interventions. Information about these problems can prevent you from misunderstanding the child’s behaviors. When these children hoard food, for example, it should not be viewed as “stealing” but as a common and predictable result of being food deprived during early childhood. A punitive approach to this problem (and many others) will not help the child mature. Instead, punishment may actually increase the child’s sense of insecurity, distress and need to hoard food. Many of these children’s behaviors are confusing and disturbing to caregivers. You can get help from professionals if you find yourself struggling to create or implement a practical and useful approach to these problems.

Parent these children based on emotional age: Abused and neglected children will often be emotionally and socially delayed. And whenever they are frustrated or fearful, they will regress. This means that, at any given moment, a ten-year old child may emotionally be a two-year old. Despite our wishes that they would “act their age” and our insistence to do so, they are not capable of that. These are the times that we must interact with them at their emotional level. If they are tearful, frustrated, overwhelmed (emotionally age two) parent them as if they were that age. Use soothing non-verbal interactions. Hold them. Rock them. Sing quietly. This is not the time to use complex verbal arguments about the consequences of inappropriate behavior.

Be consistent, predictable and repetitive: Maltreated children with attachment problems are very sensitive to changes in schedule, transitions, surprises, chaotic social situations, and, in general, any new situation. Busy and unique social situations will overwhelm them, even if they are pleasant! Birthday parties, sleepovers, holidays, family trips, the start of the school year, and the end of the school year -- all can be disorganizing for these children. Because of this, any efforts that can be made to be consistent, predictable and repetitive will be very important in making these children feel “safe” and secure. When they feel safe and secure they can benefit from the nurturing and enriching emotional and social experiences you provide them. If they are anxious and fearful, they cannot benefit from your nurturing in the same ways.

Model and teach appropriate social behaviors: Many abused and neglected children do not know how to interact with other people. One of the best ways to teach them is to model this in your own behaviors - and then narrate for the child what you are doing and why. Become a play by play announcer: “I am going to the sink to wash my hands before dinner because....” or “I take the soap and put it on my hands like this and....” Children see, hear and imitate.

In addition to modeling, you can “coach” maltreated children as they play with other children. Use a similar play-by-play approach: “Well, when you take that from someone they probably feel pretty upset so if you want them to have fun when you play this game...” By more effectively playing with other children, they will develop some improved self-esteem and confidence. Over time, success with other children will make the child less socially awkward and aggressive. Maltreated children are often “a mess” because of their delayed socialization. If the child were teased because of their clothes or grooming, it would be helpful to have “cool” clothes and improved hygiene.

Maltreated children have problems with modulating appropriate physical contact. They don’t know when to hug, how close to stand, when to establish or break eye contact, what are appropriate contexts to pick their nose, touch their genitals, or do other grooming behaviors.

Ironically, children with attachment problems will often initiate physical contact (hugs, holding hands, crawling into laps) with strangers. Adults misinterpret this as affectionate behavior. It is not. It is best understood as “supplication” behavior and it is socially inappropriate. How the adults handle this inappropriate physical contact is very important. We should not refuse to hug the child and lecture them about “appropriate behavior.” We can gently guide the child on how-to interact differently with grown-ups and other children (Why don’t you sit over here?). It is important to make these lessons clear using as few words as possible. They do not have to be directive -- rely on nonverbal cues. It is equally important to explain in a way that does not make the child feel bad or guilty.

Listen to and talk with these children: One of the most helpful things to do is just stop, sit, listen and play with these children. When you are quiet and interactive with them you find that they will begin to show you and tell you about what is really inside them. Yet as simple as this sounds it is one of the most difficult things for adults to do - to stop, quit worrying about the time or your next task and really relax into the moment with a child. Practice this. You will be amazed at the results. These children will sense that you are there just for them. They will feel how you care for them.

It is during these moments that you can best reach and teach these children. This is a great time to begin teaching children about their different “feelings.” Regardless of the activity, the following principles are important to include: (1) All feelings are okay to feel -- sad, glad, or mad (more emotions for older children); (2) Teach the child healthy ways to act when sad, glad, or mad; (3) Begin to explore how other people may feel and how they show their feelings - “How do you think Bobby feels when you push him?” (4) When you sense that the child is clearly happy, sad, or mad, ask them how they are feeling. Help them begin to put words and labels to these feelings.

Have realistic expectations of these children: Abused and neglected children have so much to overcome. And, for some, they will not overcome all of their problems. For a Romanian orphan adopted at age five after spending her early years without any emotional nurturing, the expectations should be limited. She was robbed of some, but not all, of her potential. We do not know how to predict potential in a vacuum, but we do know how to measure the emotional, behavioral, social and physical strengths and weaknesses of a child. A comprehensive evaluation by skilled clinicians can be very helpful in beginning to define the skill areas of a child and the areas where progress will be slower.

Be patient with the child’s progress and with yourself: Progress will be slow. The slow progress can be frustrating and many adoptive parents will feel inadequate because all of the love, time and effort they spend with their child may not seem to be having any effect. But it does. Don’t be hard on yourself. Many loving, skilled and competent parents have been swamped by the needs of a neglected and abused child that they have taken in.

Take care of yourself: Caring for maltreated children can be exhausting and demoralizing. You cannot provide the consistent, predictable, enriching and nurturing care these children need if you are depleted. Make sure you get rest and support. Respite care can be crucial. Use friends, family and community resources. You will not be able to help your child if you are exhausted, depressed, angry, overwhelmed and resentful.

Take advantage of other resources: Many communities have support groups for adoptive or foster families. Professionals with experience in attachment problems or maltreated children can be very helpful. You will need help. Remember, the earlier and more aggressive the interventions, the better. Children are most malleable early in life and as they get older change is more difficult.  Take advantage of this time to make a difference in a child’s life.

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From The Child Trauma Academy at www.childtrauma.org

 

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What is Fetal Alcohol Syndrome?

What is Fetal Alcohol Syndrome?

FAS is a lifelong yet completely preventable set of physical, mental and neurobehavioral birth defects associated with alcohol consumption during pregnancy.  FAS is the leading known cause of mental retardation and birth defects.

What are Alcohol-Related Neurodevelopmental Disorder (ARND) and Alcohol-Related Birth Defects (ARBD)?

Prenatal alcohol exposure does not always result in FAS—although there is no known safe level of alcohol consumption during pregnancy. Most individuals affected by alcohol exposure before birth do not have the characteristic facial abnormalities and growth retardation identified with FAS, yet they have brain and other impairments that are just as significant.

Alcohol-Related Neurodevelopmental Disorder (ARND) describes the functional or mental impairments linked to prenatal alcohol exposure, and Alcohol-Related Birth Defects (ARBD) describes malformations in the skeletal and major organ systems.

What are the Primary Characteristics of FAS, ARND and ARBD?

Individuals with FAS have a distinct pattern of facial abnormalities, growth deficiency and evidence of central nervous system dysfunction. In addition to mental retardation, individuals with FAS, ARND and ARBD may have other neurological deficits such as poor motor skills and hand-eye coordination. They may also have a complex pattern of behavioral and learning problems, including difficulties with memory, attention and judgment.

How often do FAS, ARND and ARBD occur?

As many as 12,000 infants are born each year with FAS and three times as many have ARND or ARBD. FAS, ARND and ARBD affect more newborns every year than Down syndrome, cystic fibrosis, spina bifida and Sudden Infant Death Syndrome combined.

How can Alcohol-Related Effects be prevented?

FAS, ARND and ARBD are 100% preventable when a woman completely abstains from alcohol during her pregnancy. The National Organization on Fetal Alcohol Syndrome (NOFAS) prevents alcohol-related effects through public awareness and education, and by increasing access to prenatal health care. Another key to prevention is to screen all women of reproductive age for alcohol problems and to use appropriate strategies, such as treatment for alcohol problems, to eliminate drinking before conception.

How does a mother’s drinking affect her unborn child?

When a pregnant woman drinks alcohol, so does her baby; through the blood vessels in the placenta, the mother’s blood supplies the developing baby with nourishment and oxygen. If the mother drinks alcohol, the alcohol enters her blood stream and then, through the placenta, enters the blood supply of the growing baby.

Alcohol is a teratogen, a substance known to be toxic to human development. Depending on the amount, timing and pattern of use, if alcohol reaches the growing baby’s blood supply, it can interfere with healthy development.

If a woman drinks wine, beer or liquor when she is pregnant, her baby could be born with FAS. There is no known safe amount of alcohol during pregnancy.

What if I am pregnant and have been drinking?

If you consumed alcohol before you knew you were pregnant, stop drinking now. Abstaining from alcohol for the remainder of your pregnancy can have a beneficial effect even on functions that might have been affected by earlier drinking. The sooner you stop drinking, the better the chance of having a healthy baby. You could be pregnant and not know it. So if you are trying to get pregnant or are sexually active and not using contraception, don’t drink alcohol.

The following summary is excerpted from the 10th Special Report to the U.S. Congress on Alcohol and Health produced by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The passage further describes FAS and the issues associated with prenatal alcohol exposure and serves as an introduction to the report’s comprehensive chapter on the subject. To view the full report, visit the NIAAA Web site at www.niaaa.nih.gov.

Fetal Alcohol Syndrome (FAS) is a set of birth defects caused by maternal consumption of alcohol during pregnancy. At birth, children with FAS can be recognized by growth deficiency and a characteristic set of minor facial traits that tend to become more normal as the child matures. Less evident at birth—but far more devastating to FAS children and their families—are the lifelong effects of alcohol-induced damage to the developing brain.

FAS is considered the most common nonhereditary cause of mental retardation. In addition to deficits in general intellectual functioning, individuals with FAS often demonstrate difficulties with learning, memory, attention, and problem solving as well as problems with mental health and social interactions. Thus these individuals and their families face persistent hardships in virtually every aspect of life.

Estimates of FAS prevalence vary from 0.5 to 3 per 1,000 live births in most populations, with much higher rates in some communities (Stratton et al. 1996). However, the diagnosis of FAS identifies only a relatively small proportion of children affected by alcohol exposure before birth. Children with significant prenatal alcohol exposure can lack the characteristic facial defects and growth deficiency of FAS but still have alcohol-induced mental impairments that are just as serious, if not more so, than in children with FAS. The term "alcohol-related neurodevelopmental disorder" (ARND) has been developed to describe this condition. In addition, prenatally exposed children without FAS facial features can have other alcohol-related physical abnormalities of the skeleton and certain organ systems; these are known as alcohol-related birth defects (ARBD).

Because the effects of prenatal alcohol exposure on the developing brain appear to be especially long lasting and debilitating, a significant proportion of research has concentrated on brain malformations as well as cognitive and behavioral abnormalities. In this chapter, the section on "Prenatal Alcohol Exposure: Effects on Brain Structure and Function" describes research using neuroimaging techniques to provide precise pictures of brain abnormalities found in persons exposed to alcohol before birth. The studies strongly support the notion that alcohol has specific, rather than global, effects on the developing brain. The section also describes current research on the many behavioral manifestations of this structural brain damage, including problems with cognitive and motor functions as well as mental health and psychosocial behavior.

It is unlikely that a single mechanism can explain all of the deleterious effects that result from alcohol exposure during pregnancy. As described in the section "Underlying Mechanisms of Alcohol-Induced Damage to the Fetus," alcohol exerts its effects on the developing fetus through multiple actions at different sites. In the developing brain, for example, alcohol has been shown to interfere with the development, function, migration, and survival of nerve cells. Also, in the embryonic cell layer that develops into the bones and cartilage of the head and face, alcohol exposure at critical stages of development induces premature cell death that is thought to be linked to the FAS facial defects. These actions of alcohol have provided scientists with numerous paths for pursuing possible biochemical mechanisms for these actions. Better understanding of the mechanisms may point to pharmacologic approaches for intervening or for preventing alcohol-related fetal injury.

Although research in animals and humans is continuing to provide details about alcohol-induced deficits, efforts to prevent these problems are not nearly so advanced. The section "Issues in Fetal Alcohol Syndrome Prevention" notes that numerous strategies to prevent FAS have been implemented in recent years, but that rigorous analysis of the effectiveness of these approaches is in its infancy. The section summarizes major reviews of FAS prevention efforts, presents issues related to research methods and evaluations, and describes research on prevention approaches targeted to women at different levels of risk. Recent research underscores an intensifying need for effective prevention strategies. One study found that although alcohol use among pregnant women decreased between 1988 and 1992 (from 22.5 to 9.5 percent), by 1995 it had increased to 15.3 percent (Ebrahim et al. 1998). Moreover, binge drinking (defined in the study as five or more drinks per occasion) among pregnant women, a particularly hazardous drinking pattern in terms of FAS risk, increased significantly between 1991 and 1995 (from 0.7 to 2.9 percent of pregnant women) (Ebrahim et al. 1999). In light of these unsettling findings, and because FAS and other adverse effects of drinking during pregnancy are completely preventable, the need for a solid research base to guide prevention program developers is critical.

References

Ebrahim, S.H.; Diekman, S.T.; Floyd, L.; and Decoufle, P. Comparison of binge drinking among pregnant and nonpregnant women, United States, 1991–1995. Am J Obstet Gynecol 180(1 pt. 1):1–7, 1999.

Ebrahim, S.H.; Luman, E.T.; Floyd, R.L.; Murphy, C.C.; Bennett, E.M.; and Boyle, C.A. Alcohol consumption by pregnant women in the United States during 1988–1995. Obstet Gynecol 92(2):187–192, 1998.

Stratton, K.; Howe, C.; and Battaglia, F., eds. Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment. Washington, DC: National Academy Press, 1996.

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From the National Association of Fetal Alcohol Syndrome at www.nofas.org

 

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Strategies for Parents and Caregivers of Children with FAS/FAE

Prepared by Patricia Tanner Halverson, Ph.D.

Keys to working successfully with FAS/FAE children are structure, consistency, variety, brevity and persistence. Because these children can lack internal structure, caretakers need to provide external structure for them. It is important to be consistent in response and routine so that the child feels the world is predictable. Because of serious problems maintaining attention, it is important to be brief in explanations and directions, but also to use a variety of ways to get and keep their attention. Finally, we must repeat what it is we want them to learn, over and over again.

Many FAS children:

·         Have difficulty structuring work time.

·         Show impaired rates of learning.

·         Experience poor memory.

·         Have trouble generalizing behaviors and information.

·         Act impulsively.

·         Exhibit reduced attention span or is distractible.

·         Display fearlessness and are unresponsive to verbal cautions.

·         Demonstrate poor social judgment.

·         Cannot handle money age appropriately.

·         Have trouble internalizing modeled behaviors.

·         May have differences in sensory awareness (Hypo or Hyper).

·         Language Production higher than comprehension.

·         Show poor problem solving strategies.

Effective strategies include:

·         Fostering independence in self-help and play.

·         Give your child choices and encourage decision-making.

·         Focus on teaching daily living skills.

·         Encourage the use of positive self talk.

·         Have child get ready for next school day before going to bed.

·         Establish a few simple rules. Use identical language to remind them of the rules. "This is your bed, this is where you are supposed to be."

·         Establish routines so child can predict coming events.

·         Give child lots of advance warning that activity will soon change to another one.

·         For unpredictable behavior at bedtime/mealtime, establish a firm routine.

·         Break their work down into small pieces so they do not feel overwhelmed.

·         Be concrete when teaching a new concept. Show them.

Discipline:

·         Set limits and follow them consistently.

·         Change rewards often to keep interest in reward getting high.

·         Review and repeat consequences of behaviors. Ask them to tell you consequences.

·         Do not debate or argue over rules already established. "Just do it."

·         Notice and comment when your child is doing well or behaving appropriately.

·         Avoid threats.

·         Redirect behavior.

·         Intervene before behavior escalates.

·         Avoid situations where child will be over stimulated.

·         Have child repeat back their understanding of directions.

·         Protect them from being exploited. They are naive.

·         Have pre-established consequences for misbehavior.

 

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From the National Association of Fetal Alcohol Syndrome at www.nofas.org

 

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List of FAE/FAS Books

The Broken Cord, By Michael Dorris (1989)

This is the true story of an American Indian child adopted from a reservation and his adoptive father’s search to understand FAS.

 

Harper & Row Publisher

Cost: Approximately $13.00 paperback

Phone: Contact your local bookstore or library

 

The Challenge of Fetal Alcohol Syndrome: Overcoming Secondary Disabilities, Edited by Ann Streissguth and Jonathan Kanter (1997)

This book contains proceedings from the International FAS Conference in Seattle, WA.

 

Order from: University of Washington Press, P.O. Box 50096, Seattle, WA 98145-5096.

Cost: $17.95, plus $4.00 for shipping; Phone: 1-800-441-4115

E-mail: uwpress@u.washington.edu Web site: www.washington.edu/uwpress/

 

Fantastic Antone Grows Up, Edited by Kleinfield, Morse & Wescott (2000)

 

This is a sequel to the book Fantastic Antone Succeeds. It provides a guide to life with an adolescent or young adult with FAS and other alcohol-related disabilities. Includes a compilation of articles with over 35 contributors.

 

Order from: University of Alaska Press, PO Box 756240, Fairbanks, AK 99775

Cost: $20 paperback

Phone: 1-888-252-6657 Fax: 907-474-5502

E-mail: fypress@uaf.edu Web site: www.uaf.edu/uapress

 

Fantastic Antone Succeeds! Experiences in Educating Children with Fetal Alcohol Syndrome, Edited by Kleinfeld & Wescott (1993)

This book discusses different strategies used by parents, teachers, social workers and others that have been helpful in overcoming the challenges faced by young people with FAS.

 

Order from: University of Alaska Press, PO Box 756240, Fairbanks, AK 99775

Cost: $30 hardback, $20 paperback

Phone: 1-888-252-6657 (toll-free) Fax: 907-474-5502

E-mail: fypress@uaf.edu Web site: www.uaf.edu/uapress

 

 

 

FAS/E: A Standard of Care for Toddlers, Children, Adolescents and Adults

 

This brief booklet, written in 1998, includes ideas and suggestions from families concerning interventions for toddlers, children, adolescents and adults who have FAS/E.

 

Order from: The FAS Family Resource Institute (FAS*FRI)

Cost: $10.00

Phone: 253-531-2878

 

Fetal Alcohol Syndrome: A Guide for Families and Communities (1997), By Ann Streissguth, Ph.D.

 

This guidebook presents an overview of FAS, explains how to identify the disorder, and provides a wealth of information for families affected by FAS.

Order from: Paul H. Brookes Publishing Company,

P.O. Box 10624, Baltimore, MD 21285

Cost: $22.95 paperback, 336 pages

Phone: 1-800-638-3775 Fax: 410-337-8539

E-mail: custserv@brookespublishing.com Web site: www.brookespublishing.com

 

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Causes of Bedwetting (Enuresis)

Physical Factors:

·         Heredity – 40% to 55% of bedwetting children have parents or a close relative with a similar problem.

·         Slow maturation – a developmental lag interacting with poor training practices.

·         Sleep arousal disorders – Do they wet because they sleep too soundly or do they sleep soundly because they know they will wet and they need to get some sleep?

·         Small bladder capacity – difficulty holding urine both day and night.

·         Urinary tract infections – the result of bedwetting that exacerbates the problem.

·         Anatomical defects – spinal injuries etc.

·         Constipation – large fecal mass can decrease bladder capacity.

·         Allergies – incidence of bedwetting in higher in females with allergies.

 

Psychological Factors:

·         Emotional disturbance – 1 in 5 bed-wetting children is emotionally disturbed.  When bedwetting is corrected there is a decrease in emotional disturbance.

·         Parental toilet training practices – early training or rigidly strict, inconsistency and frequent use of punishments.

·         Faulty learning – common in children with mental retardation.

 

 

References to Help Parents and Children:

Dry All Night, by Alison Mack

How to Help Children with Common Problems, By C.E. Shaefer & H.L. Mellman

 

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A. Patricia Miller, O.T.R., 448 Arbor Creek Drive, Euless, Texas

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Treatment Approaches for Enuresis

Enuresis – The repeated, involuntary discharge of urine after the age of three years.

Incidence – Incidence declines with age.  Whereas about 20-25% of 4-5 year olds still bed wet; the number declines to 10% of 6-10 year olds, and, finally, to about 3% in the teen years and in adulthood.

 

Treatment Approaches:

·         Medical exam

·         Bell and pad conditioning method

·         Retention control training

·         Drug treatment

·         Psychodynamic approach

·         Rewards and penalties

·         Nightly awakening

·         Counseling

·         Responsibility training

·         Combined approaches

 

–

A. Patricia Miller, O.T.R., 448 Arbor Creek Drive, Euless, Texas

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Enuresis Advice

In regard to advice giving, some families may not know the following:

1.      The use of harsh punishment, shaming, or ridicule when a child wets can exacerbate the problem.

2.      Restricting fluids at bedtime is not helpful.  Indeed, fluid restriction may exacerbate the enuresis problem by inducing bladder neck irritation and the urge to urinate at lower than normal volumes of bladder urine.

3.      Positive reinforcement for dry nights seems much more effective in the long run.

4.      The child is not wetting the bed because he is lazy or obstinate or rebellious.  It is most likely because his bladder control is slow in developing and has become anxious about the problem.  The child should be clearly told that the problem is not his fault.

5.      The family should understand that enuresis is a very common childhood problem and, that, typically, it is not a sign of an underlying emotional disturbance.

6.      There are a number of very effective treatment methods for enuresis and the odds are very high that the problem can be corrected within a few months.

7.      Facts about the basic physiology of the bladder can help one understand the problem

 

 

 

 

–

A. Patricia Miller, O.T.R., 448 Arbor Creek Drive, Euless, Texas

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End Bedwetting – Data Log:  Phase 1

Date	Wet	Dry	Bedtime	Push-ups	Bladder Stretches	Bladder Capacity (oz)	Bathroom Trips	Evening Drinks

A. Patricia Miller, O.T.R., 448 Arbor Creek Drive, Euless, Texas

 

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Encopresis Assessment

A.                 Medical Exam:  to rule out a medical basis

B.                 Facts to know:

1.       Has the child ever achieved bowel training?

2.       Were coercive toilet training practices present?

3.       Is there a history of stomach pains or gastrointestinal (GI) problems?

4.       At what age was continence lost?

5.       Are there psychological problems other than soiling?

6.       What events seem to lead up to or coincide with soiling?

7.       What is the nature of previous attempts by parents and/or therapists to eliminate the problem?

8.       List the rewards the child will work for.

9.       Is there a family history of bowel or GI difficulties?

10.   If psychological factors seem to be a causative factor in the soiling, do these factors still exist?

11.   What are the child-rearing strategies employed by parents that may be deleterious?

12.   Is there any fear of the toilet due to previous trauma or pain?

 

Childhood Encopresis & Enuresis: Causes & Therapy by Charles E. Schaefer, Ph.D.

A. Patricia Miller, O.T.R., 448 Arbor Creek Drive, Euless, Texas

 

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Encopresis: Elements of Treatment

1.            A detailed history and physical exam.

2.            Offer parents and child a plausible, non-blaming explanation of the causes of the disorder.

3.            Establish an expectation of success within a realistic time period.

4.            Knowledge of normal bowel function by all concerned is most helpful.

5.            Daily recording of accidents and appropriate eliminations, and posting these results.

6.            An incentive program contingent on bowel movements in the toilet and clean pants.

7.            Knowledge of effective toileting practices.

8.            If child is fearful of the toilet, desensitize the child to the toilet.

9.            The child’s cooperation and active involvement in the treatment should be solicited.

10.        Training for the parents and child in administering enemas or suppositories in a non-aversive manner.

11.        Gradual phasing out of incentives.

12.        Consistency by parents in administering the treatment program.

13.        Often the child’s underwear has to be numbered to prevent hiding attempts.

14.        Encourage the child to follow a reasonable diet that is high in bulk or fiber content (fruit, vegetables, and bran).

15.        Establish regular bowel habits but not to the point of obsession or panic.

16.        Help the child kick the laxative habit.

Childhood Encopresis & Enuresis: Causes & Therapy by Charles E. Schaefer, Ph.D.

A. Patricia Miller, O.T.R., 448 Arbor Creek Drive, Euless, Texas

 

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Definitions of Terms: Encopresis

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The AFCARS Report

US Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau, www.acf.hhs.gov/programs/cb

 

Preliminary FY 2001 Estimates as of March 2003 (8)

 

 

How many children were in foster care on September 30, 2001?     542,000

 

SOURCE:  Adoption and Foster Care Analysis and Reporting System (AFCARS) data submitted for the FY 2001, 10/1/00 through 9/30/01.

 

NOTES:  Data from both the regular and revised submissions received by January 21, 2003 are included in the estimates. (See TAR 5 for detailed discussion of the various estimation procedures that have been utilized.) Missing data are not used in the calculation of percentages. Some percentages do not total 100% and/or the estimated numbers do not add up to the total number in the category due to rounding.

 

 

What were the ages of the children in foster care?				What were the placement settings of children in foster care?
Mean Yrs	10.1			Pre-Adoptive Home	4%	20,289
Median Yrs	10.6			Foster Family Home (Relative)	24%	130,869
				Foster Family Home (Non-Relative)	48%	260,384
Under 1 Yr	4%	22,957		Group Home	8%	43,084
1 thru 5 Yrs	24%	130,857		Institution	10%	56,509
6 thru 10 Yrs	24%	127,711		Supervised Independent Living	1%	5,068
11 thru 15 Yrs	30%	160,419		Runaway	2%	9,112
16 thru 18 Yrs	17%	89,632		Trail Home Visit	3%	16,685
19+ Yrs	2%	10,424
What were the lengths of stay in foster care?				What were the case goals of the children in foster care?
Mean Months Median Months	33 19			Reunify with Parent(s) or Principal Caretaker(s)	44%	241,051
				Live with Other Relative(s)	5%	26,555
<1 Month	4%	22,512		Adoption	22%	116,653
1 to 5 Mos	17%	91,533	&nb