One of those questions that courts and social workers ask is this: “Is the kid in therapy?” The correct answer is: “Yes”, and they will go away happy. Unfortunately, while that will make them happy, chances are, unless you are very lucky or drive it yourself, it will make very little difference in your and your kid’s life, and sometimes makes things worse (yes, it happens).

This sounds harsh, but is my experience over something like more than a dozen therapists and psychiatrists in the course of a dozen years, some with PhDs and all. Now, I don’t want to put down therapists and their profession. It’s just that there is no miracle dust called “therapy” — if you sprinkle it all over your kid, everything will be fine. That would be nice, but it ain’t so. What a therapist can and cannot do will be a separate upcoming post, but before we get there, let’s look at what problems your kid might have that a therapist might be able to help with. And to get that started, let’s look at the salad of strange psychological terms that will be used by therapists (and your kid’s school) as their “diagnosis” for your kid:

• First, there is the all-around catch-all diagnosis: “ADHD”/”ADD” (Attention Deficit/Hyperactivity Disorder) and perhaps other variations of the basic idea. Chances are very good your kid will be diagnosed as having ADHD at some point or other. What does that mean for the kind of kids with a difficult past that we have? As the very first child therapist we saw explained, and I totally agree, it means “The adults want the kid to sit and be quiet and focus on something we tell them to do, but the kid fidgets, or runs around, or talks loudly, or does something else, and the kid won’t stop, regardless what we adults do.” I would call it “We don’t have any clue what is going on with this kid, and so we call it ADHD”. Usually what follows is prescription tranquilizers, without having any idea what’s going on. I’ll have more to say about this later, but for now, your takeaway is two points: 1) in your personal life, forget about ADHD, whether your kid does or does not have that diagnosis will not change what you do so there is no point spending any extra time on it, 2) in schools that are subject to the American With Disabilities Act (i.e. US schools) or something similar in other countries, you can use an ADHD diagnosis as your lever to get special services for your kid. It’s something schools know how to deal with bureacratically, and so using it makes your job a lot easier to get the school to do the best they can for your kid.
• Attachment disorder/reactive attachment disorder/RAD. This is a given for any kid who has been removed from their birth parents for any period of time. You can read up smart writings about it, but the essence is very simple: Kids need the uninterrupted emotional connection to their birth parents, and bad things happen to their mind and their soul if they don’t have that all the time. Your foster kid, by definition, does not have that, otherwise they wouldn’t be in your home. If there is a single diagnosis you want to spend your time on researching, this is it.
• Post-traumatic stress disorder (PTSD). If a terrorist captures you and threatens to kill you and your family, you get PTSD. Even if you get out, you probably will have nightmares for a long time, and get easily rattled during the day, among other problems. Your kid is like that, except probably worse: instead of a single traumatic event, your kid will likely have experienced many over a number of years: from abuse and neglect to the removal from a birth home (a very traumatic event in itself) or separation from siblings. Also, because they were little when it happened, they could not explain what happened to themselves as you can, and so it is even more overwhelming to them than it would be to you.

These three apply to most (all IMHO) foster kids, regardless of their particular history. There can be others, of course, such as frequently seen:

• Fetal alcohol syndrome/FAS: the damage that was done by the birth mother consuming, possibly large, amounts of alcohol during pregnancy.  I know little about that.
• Depression. If everything had happened to you that happened to your little one, do you think you would not be depressed? Enough said, of course they are depressed! Chances are that if you are doing a good job as a parent, and work on the other items in this post, the depression will go away on its own.
• Anxiety disorders. If you don’t know in whose bed you will wake up in the morning, and you totally depend on adult strangers who may or may not be nice people, would you be anxious? Duh. Your being a committed parent is the first-line remedy here.
• Somatic issues. Your kid reports all kinds of pains and disease symptoms, but you and the doctor see no sign of illness. The short version: your kid is in emotional pain (duh! of course they are!) and asks you to help. You don’t need to do any miracles, just emphatically acknowledge that the kid is in pain, and that you are there for them. (No, you won’t do all/most of what the kid wants you to do to fix it, but you are very emotionally available, that will be a better fix)

If your kid is being diagnosed with any of the following, it is time for you to perk up your eyes and ears and be very attentive about whether that’s really that. If a therapist diagnoses any of those, I would immediately find a second and/or third opinion of a therapist who has substantial experience working with abused and neglected children.  (Interview them! Ask for whether more than 50% of the patients they see are kids with an abuse/neglect background, and spend no time or attention on those who do not. Our kids are a different ballpark.) With one of those diagnoses, the danger is that your kid gets labeled, and people — perhaps you included — stop seeing the world from the eyes of the kid. And I really don’t want you to do that because the diagnosis may very well not be correct. So here’s my list:

• Bipolar disorder, formerly known as manic-depressive disorder. The basic symptoms are that your kid sometimes is completely hyper, and cannot be stopped, and some other times completely lethargic and cannot be cajoled to do anything. The trouble with this diagnosis is that neither you nor your therapist can tell whether there is truly a “chemical imbalance in the brain” or it’s basically PTSD that your kid is trying to manage by distracting themselves really hard from their bad memories. It may be so, or it may not be. The standard “treatment” is medication, and you want to avoid that if it isn’t actually bipolar disorder.
• Oppositional defiant disorder, conduct disorder, antisocial personality disorder, etc. Personally I have my doubts that these disorders really exist for anybody, but even if they do for grown adults, they do not for little children. Lack of parenting disorder may be a better way of looking at it, and you are the expert on fixing it. I’m not kidding.

As your kid gets older, you may encounter:

• Sexual acting out. Way too much sex with way too many partners, perhaps of both sexes, without ever establishing much of a relationship. In-your-face sexuality, etc. etc. This is just the teenage version of everything I wrote about above. Try to keep the kid as safe from pregnancy, diseases, and bad relationships as you can, but never risk the connection that you have to the kid. You will not be able to influence their behavior at all if the relationships cracks, so don’t let that happen.
• Alcohol and substance abuse. I don’t have any experience with that. I would get lots of professional advice, but focus my own actions on building and strengthening the relationship to the kid.
• Truancy, perhaps petty theft or worse. Chances are the kid does this due to the cameraderie (to compensate for Attachment and self-worth issues), the “respect” from peers, and because they have little appreciation just how badly these things can mess up their life. They may also think they will never have a life and die young, so why care. Again, make clear what you stand for in life, and that you will always love them, regardless of what they might do in life.

Finally, this is not something therapists usually label as a diagnosis, but I might as well add it:

• Incredibly low sense of self and self-esteem. Image you say “I want …” to an abusive parent, and get praise for asserting your own wishes. It is hard to imagine. So it’s difficult for abused kids to start developing a healthy sense of self. This comes out in a thousand ways, including looking like depression. Why doesn’t this kid get out of bed and play soccer with all the other kids in the park? It may be they are depressed; it may also be they cannot imagine being just like the other kids, doing what kids do, because they aren’t worth what other kids are worth. Your basic intervention is to take every opportunity to be amazed at something your kid did, like the amazingly beautiful paintings they bring home from school, or that they lined up the toy cars in a line! How amazing they are to do that! It will take a long time, but you are in a better position than anybody to do something about it.

Like about almost anything else. Which is, of course, why you are doing this in the first place.

(Written previously: Phase 3: Testing)

The bad news is that Phase 3: Testing is not going to go away any time soon or perhaps ever. The good news is that there’s a good chance that blow-ups are going to happen less frequently over time.

How quickly things calm down depends on many things, but you can make it happen faster by doing what I said in the previous post: remain positive and understanding towards your kid, regardless what they are doing when they oppose you as hard as they can. Over time, they will hopefully realize that you not going to be dangerous to them, or rejecting them, even if they put on their very worst behavior over and over again.

And that’s when you can start building a long-term relationship with your kid, one of the reasons you got into this in the first place. This will be 4 steps forward and 3.5 back (sometimes 8 back), so don’t expect miracles, but if you made it through Phase 3 in one piece, you are well on your way.

In this phase, it will likely become much clearer to you where your kid really is developmentally, and what their hopes and fears actually are.  As unlikely as it sounds, here’s my rule of thumb:

Go through whatever information you have about the history of your kid, and find out how old the kid was when the first significant trauma (glossary) occurred. If, say, they entered foster care at age 4, you know that the trauma occured at age 4, or likely earlier (perhaps all the way to before birth … yes, kids can have traumatic memories from before birth).

Take that age, and assume that your kid is really that young and not a bit older. So if you talk to a big hulk of a 16-year-old but his trauma history goes back to age 3, assume that emotionally he’s 3, not 16. As strange as it sounds, if you do that, particularly during conflict, you will be reacting in ways that are going to be much more successful than if you think the kid is as old as his birth certificate says.

And then, if your kid is distressed by whatever, try to understand why and how by thinking of your kid as a very young child, and how such a very young child would be distressed. I admit that after all these years, I still have difficulties doing this. It is not a very natural response! “Shouldn’t she start acting like she’s xxx years old, because she is?” Well, yes, but it’s really difficult if you are 10 years younger, and terrified. It’s really hard to grow up and mature if you are terrified. First the little kid needs to be taken care of.

I have much more to say about that later.

There might be a phase after that. It’s when you forgot it all, and you have just the relationship with your now-adult kid you always wanted, and the troubles are behind you. I don’t know how many foster parents ever get there. I’m not there yet myself, although sometimes I see tantalizing glimpses that such a future might not be entirely impossible.