The negative effects of foster care
Individuals who were in foster care experience higher rates of physical and psychiatric morbidity that the general population. In a study of adults who were in foster care in Oregon and Washington state, they were found to have double the incidence of Depression ,20% as compared to 10% , they were found to have a higher rate of Post Traumatic Stress Disorder (PTSD) than combat veterans with 25% of those studied having PTSD. Children in foster care have a higher probability of having Attention Deficit Hyperactivity Disorder, and deficits in executive functioning, anxiety as well other developmental problems.These children experience higher degrees of incarceration, poverty, homelessness, and suicide. Recent studies in the U.S., suggests that, foster care placements are more detrimental to children than remaining in a troubled home.
Negative environmental influences affect various aspects of neurodevelopment, such the formation of neurons and dendrites.Foster care has been shown in various studies, to have deleterious consequences on the physical health and mental wellbeing of those who were in foster care. Many children enter foster care at a very young age. The human brain doesn’t fully develop until approximately the age of twenty, one of the most critical periods of brain development occurs in the first 3-4 years.
The processes that govern the development of personality traits, stress response and cognitive skills are formed during this period. The developing brain is directly influenced by negative environmental factors including lack of stimulation due to emotional neglect, poor nutrition, exposure to violence in the home environment and child abuse.
Negative environmental influences have a direct effect on all areas of neurodevelopment, neurogenesis (creation of new neurons), apoptosis (death and reabsorption of neurons), migration (of neurons to different regions of the brain), synaptogenesis (creation of synapses), synaptic sculpturing (determining the make-up of the synapse), arborization (the growth of dendritic connections , myelinzation (protective covering of neurons), an enlargement of the brain’s ventricles and can cause cortical atrophy. Most of the processes involved in healthy neurodevelopment are predicated upon the establishment of close nurturing relationships and environmental stimulation. Foster children have elevated levels of cortisol, a stress hormone in comparison to children raised by their biological parents, elevated cortisol levels can comprimise the immune system. (Harden BJ, 2004). Negative environmental influences during this critical period of brain development can have lifelong consequences.
 Epigenetic effects of environmental stress
epigentic mechanismsEpigenetics is the effect environmental factors have on gene expression. Negative environmental influences such as maternal deprivation, child abuse and stresshave been shown to have a profound effect on gene expression including transgenerational epigenetic effects in which physiological and behavioral (intellectual) transfer of information across generations not yet conceived is effected.Many physiological and behavioral characteristics ascribed to Mendelian inheritance is due in fact to transgenerational epigenetic inheritance. The implications in terms of foster care and the cost to society as a whole is that the stress, deprivation and other negative environmetal factors many foster children are subjected has a detrimental effect not only their physical, emotional and cognitive well-being but the damage can transcend generations.
In studies of the adult offspring of Holocaust survivors, parental PTSD was risk factor for the development of PTSD in adult offspring in comparison to those whose parents went through the Holocaust without developing PTSD. The offspring of survivors with PTSD had lower levels urinary cortisol excretion, salivary cortisol and enhanced plasma cortisol suppression in response to low dose dexamethasone administration than offspring of survivors without PTSD. Low cortisol levels are associated with parental, particularly maternal, PTSD. This is in contrast to the normal stress response in which cortisol levels are elevated after exposure to a stressor. The results of the study point to the involvement of epigenetic mechanisms.
“In addition, the effects of abuse may extend beyond the immediate victim into subsequent generations as a consequence of epigenetic effects transmitted directly to offspring and/or behavioral changes in affected individuals. (Neighh GN et al 2009)
It has been suggested in various studies that the deleterious epigentic effects may be somewhat ameliorated through pharmacological manipulations in adulthood via the the administration of nerve growth factor-inducible protein A,and through the inhibition of a class of enzymes known as the histone deacetylases (HDACs). “HDAC inhibitors (HDACIs) such as Trichostatin A (TSA); “TSA can be used to alter gene expression by interfering with the removal of acetyl groups from histones”, and L-methionine an essential amino acid, have been developed for the treatment of a variety of malignancies and neurodegenerative disorders. Drug combination approaches have also shown promise for the treatment of mood disorders including bipolar disorder, anxiety and depression.”
 Post Traumatic Stress Disorder
Regions of the brain associated with stress and post traumatic stress disorderChildren in foster care have a higher incidence of Post traumatic stress disorder (PTSD).In one study (Dubner and Motta, 1999) 60% of children in foster care who had experienced sexual abuse had PTSD, and 42% of those who had been physically abused fulfilled the PTSD criteria. PTSD was also found in 18% of the children who were not abused. These children may have developed PTSD due to witnessing violence in the home.(Marsenich, 2002).
In a study conducted in Oregon and Washington state, the rate of PTSD in adults who were in foster care for one year between the ages of 14-18 was found to be higher than that of combat veterans, with 25 percent of those in the study meeting the diagnostic criteria as compared to 12-13 percent of Iraq war veterans and 15 percent of Vietnam war veterans, and a rate of 4% in the general population. The recovery rate for foster home alumni was 28.2% as opposed to 47% in the general population.
“More than half the study participants reported clinical levels of mental illness, compared to less than a quarter of the general population”. 
 Eating disorders
Foster children are at increased risk for a variety of eating disorders, in comparison to the general population.
Obesity children in foster care are more prone to becoming overweight and obese, and in a study done in the United Kingdom, 35% of foster children experienced an increase in Body Mass Index (BMI) once in care.
Hyperphagic Short Stature syndrome (HSS) is a condition characterized by short stature due to insufficient growth hormone production , an excessive appetite (hyperphagia) and mild learning disabilities. While it is believed to have genetic component, HSS is triggered by being exposed to an environment of high psychosocial stress, it is not uncommon in children in foster homes or other stressful environments. HSS improves upon removal from the stressful environment.
Food Maintenance Syndrome is characterized by a set of aberrant eating behaviors of children in foster care it is “a pattern of excessive eating and food acquisition and maintenance behaviors without concurrent obesity”, it resembles “the behavioral correlates of Hyperphagic Short Stature”. (Tarren-Sweeney M. 2006). It is hypothesised that this syndrome is triggered by the stress and maltreatment foster children are subjected to, it was prevalent amongst 25 percent of the study group in New Zealand.
Bulimia Nervosa is seven times more prevalent among former foster children than in the general population. 
 Disorganized attachment
A study by Dante Cicchetti found that 80% of abused and maltreated infants in his study exhibited symptoms of disorganized attachment. Children with histories of maltreatment, such as physical and psychological neglect, physical abuse, and sexual abuse, are at risk of developing psychiatric problems. These children may be described as experiencing trauma as the result of abuse or neglect, inflicted by a primary caregiver, which disrupts the normal development of secure attachment. Such children are at risk of developing a disorganized attachment. Disorganized attachment is associated with a number of developmental problems, including dissociative symptoms, as well as depressive, anxiety, and acting-out symptoms.
 Child abuse
Children in foster care experience high rates of child abuse, emotional and physical neglect. In one study in the United Kingdom “foster children were 7-8 times and children in residential care 6 times more likely to be assessed by a pediatrician for abuse than a child in the general population”.
 Poverty and homelessness
New York street children; Jacob Riis, 1890Nearly half of foster kids in the U.S. become homeless when they turn 18.Most foster care children should be placed in adoptive homes. “One of every 10 foster children stays in foster care longer than seven years, and each year about 15,000 reach the age of majority and leave foster care without a permanent family—many to join the ranks of the homeless or to commit crimes and be imprisoned.
Three out of ten of the United States homeless are former foster children.According to the results of the Casey Family Study of foster Care Alumni up to 80 percent are doing poorly with a quarter to a third of former foster children at or below the poverty line, three times the national poverty rate.Very frequently, people who are homeless had multiple placements as children: some were in foster care, but others were “unofficial” placements in the homes of family or friends. Individuals with a history foster care tend to become homeless at an earlier age than those who were not in foster care and Caucasians who become homeless are more likely to have a history of foster care than Hispanics or African Americans. The length of time a person remains homeless is prolonged in indiviuals who were in foster care.
 Suicide rate
Children in foster care are at a geater risk of suicide, the increased risk of suicide is still prevalent after leaving foster care. Those who spent time in foster care have a higher incidence of suicide than the general populatiion. In a study of Texas youths who aged out of the system 23 percent had a history of suicide attempts.
A large scale study conducted in Sweden utilizing the data of almost one million people including a group of 22,305 former foster children who had been in care prior to their teens found that:
“Former child welfare clients were in year of birth and sex standardised risk ratios (RRs) four to five times more likely than peers in the general population to have been hospitalised for suicide attempts….Individuals who had been in long-term foster care tended to have the most dismal outcome…former child welfare/protection clients should be considered a high-risk group for suicide attempts and severe psychiatric morbidity.”
 Death rate
Children in foster care have an overall higher mortality rate than children in the general population.A study conducted in Finland among current and former foster children up to age 24 found a higher mortality rate due to substance abuse, accidents, suicide and illness. The deaths due to illness were attributed to an increased incidence of acute and chronic medical conditions and developmental delays among children in foster care.
 Poor academic prospects
Foster care has been proven in innumerable studies to not be conducive to academic performance. In a study conducted in Philadelphia by John Hopkins University it was found that; among high school students who are in foster care, have been abused and neglected, or receive out of home placement by the courts, the probability of dropping out of school is greater than 75%.
Among the statistics compiled by the Northwest Alumni Study which was conducted in association with the Harvard Medical School, in regard to high school completion and post-secondary education among those formerly in foster care it was found:
56% completed high school compared to 82% of the general population, although an additional 29% of former foster children received a G.E.D. and an additional 5% of the general population.
42.7% completed some education beyond high school.
20.6% completed any degree or certificate beyond high school
16.1% completed a vocational degree; 21.9% for those over 25.
1.8% complete a bachelors degree , 2.7% for over 25, the completion rate for the general population in the same age group is 24%, a sizable difference.
 State abuses
 Drug testing
Throughout the 1990s, experimental HIV drugs were tested on HIV-positive foster children at Incarnation Children’s Center in Harlem. The agency has also been accused of racism, some comparing the trials to the Tuskegee syphilis experiment, as 98 percent of children in foster care in New York City belong to ethnic minorities.
 The lost children
Children victimized by the United Kingdom’s Childrens Migrant ProgrammeAn estimated 150,000 British children were sent to overseas colonies and countries in the commonwealth such as Australia. This practice was in effect from the beginning of the nineteenth century until 1967. Many of these children were sent to orphanages, foster homes and religious institutions, where they were used as a free source of labor and many were severely abused and neglected. These children were classified as orphans although most were not. In the period after World War II the policy was dubbed the “Child Migrants Programme”. The prime consideration was money as it was cheaper to care for children in commonwealth countries than it was in the United Kingdom. This program was carried out with the complicity of the Methodist Church, the Catholic Church and the Salvation Army among others. At least 10,000 children some as young as 3 were shipped to Australia after the war,, most to join the ranks of the “Forgotten Australians”, the term given for those who experience care in foster homes and institutions in the 20th century. Among these Forgotten Australians were members of the “Stolen Generation”, the children of Australian Aborigines, forcibly removed from their homes and raised in white institutions. In 2009 Australian Prime Minister, Kevin Rudd apologised to the approximately 500,000 “forgotten Australians” and in 2010 British Prime Minister Gordon Brown issued a similar apology to those who were victimised by the Child Migrants Programme. 
 Therapeutic Intervention
The negative physical, psychological, cognitive and epigenetic effects of foster care have been established in innumerable studies in various countries. The Casey Family Programs Northwest Foster Care Alumni Study was a fairly extensive study into various aspects of the psychosocial effects of foster care noted that 80% of ex-foster children are doing “poorly”.
The human brain however has been shown to have a fair degree of neuroplasticity.Adult Neurogenesis, has been shown to be an ongoing process.
“… all those experiences are of much significance which show how the judgment of the senses may be modified by experience and by training derived under various circumstances, and may be adapted to the new conditions…” – Hermann von Helmholtz, 1866
While having a background in foster homes especially in instances of sexual abuse can be the precipitating factor in a wide variety of psychological and cognitive deficits such as ADHD,and PTSD it may also serve to obfuscate the true cause of any underlying issues, there should be no automatic assumptions, it may have nothing to do with, or may be exacerbated by having a history of foster care and the attendant abuses.