Posttraumatic stress in preschool children in foster care : The influence of the foster parents

Introduction. It can be argued that preschool children in foster care are at high risk for developing posttraumatic stress disorder (PTSD) and further mental health problems as consequence of the high exposure to potentially traumatic events. However, a systematic literature review (Publication I) showed that PTSD in this population has not been investigated yet. Previous studies have demonstrated that foster parentsa characteristics, such as foster parentsa stress, parenting, and family functioning, affect foster childrena s mental health in general, without considering the consequences of trauma exposure. The aim of the current dissertation project was to explore the distribution of PTSD in preschool children in foster care and to investigate how foster parents impact childrena s PTSD, further mental health symptoms, and therapeutic service utilization following trauma exposure. Finally, a meta-model integrating the impact of foster parents as well as the association between the childrena s outcomes PTSD and further mental health problems was developed and tested. Method. Data were collected in Germany using a cross-sectional design. Foster parents of 324 children aged 3 to 7 years completed online or paper-and-pencil questionnaires about childrena s PTSD, internalizing and externalizing symptoms, therapeutic service utilization, foster parentsa stress levels, parenting in disciplinary situations, and family functioning. Frequency analyses, regression models, and structural equation modeling were applied. Results. Approximately 45.4% of preschool children in foster care experienced potentially traumatic events. The prevalence of PTSD was estimated between 7.1% and 15.4% using a PTSD screening, the DSM-5, and the ICD-11 criteria. Foster parentsa stress was associated with childrena s PTSD (Publication II), further mental health problems (Publication III), and perceived need for therapy for the child (Publication IV). The findings concerning parenting were inconsistent, showing some evidence that laxness and verbosity as parenting styles moderate the impact of trauma exposure on externalizing symptoms (Publication III). Furthermore, an integrative meta-model excluding parenting in disciplinary situations fit the empirical data. Conclusions. The findings demonstrate the high mental health needs of trauma-exposed children in foster care. They also suggest that foster parents have an important and complex impact in the way children cope with trauma. Hence, child welfare agencies should properly prepare and support foster parents by enhancing their stress regulation and coping strategies. Further research is needed to identify dimensions of foster parentsa parenting behavior that are important for the posttraumatic adaption of preschool children in foster care.