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For a long time it was assumed that very young children cannot experience symptoms of posttraumatic stress disorder (PTSD); the common stance was that they are not able, at this early age, to appraise an experience as traumatic, or to develop symptoms such as re-experiencing, since their memory is still developing. Over the past 25 years, research has supported the validity of PTSD in preschool children (Scheeringa, 2011). Different populations were examined in this context – victims of accidental traumatic events, life-threatening illness, natural disaster, and children who witnessed intimate partner violence. However, the highly vulnerable population of young children living in foster care is still left outside the research interest.

For half of them, maltreatment was the main reason to be placed in a foster family (Statistisches Bundesamt, 2016). It can be argued that they have, therefore, high rates of PTSD symptoms. Taking the young child out of such toxic environment aims at reducing further impairments of the child’s mental health and well-being. However, the impact of maltreatment does not end there. Children could continue suffering from PTSD and the foster family may buffer the way children cope with trauma (Orme & Buhler, 2001). Unfortunately, many child welfare services do not address this in their routine procedures. In Germany, there are about 600 child welfare services, governmental and private. All of them are organizing the way they prepare foster parents and support children in foster care very differently. For example, services to prepare foster parents range from providing reading materials to systematic trainings.

The Foster Care Project at the University of Bremen gives first insights about PTSD symptoms in young children in foster care and the impact of their foster family. According to foster parents’ knowledge and estimations nearly half of the studied children aged 3 to 7 years experienced s potentially traumatic events. About 11.7% to 15.4% were suspected to have PTSD diagnosis which is higher than the rate of German-speaking young children with accidental traumatic experiences (e.g., Graf, Schiestl, & Landolt, 2011). Furthermore, foster parents’ stress was associated with children’s PTSD symptom severity. Since we only had cross-sectional data, it remains unclear if foster parents’ stress influenced young children’s mental health or vice versa. Most likely, there is rather a reciprocal relationship (Neece, Green, & Baker, 2012). Regardless of the direction of this association, the implications are unambiguous:  Child welfare services should prepare the foster parents in a better way by improving their stress management: Foster parents will provide calm and nurturing environment for their children, so that they could cope with the trauma. In the other way around, they will react less distressed to their children’s symptoms.


Graf, A., Schiestl, C., & Landolt, M. A. (2011). Posttraumatic stress and behavior problems in infants and toddlers with burns. Journal of Pediatric Psychology, 36, 923-931. doi: 1093/jpepsy/jsr021

Neece, C. L., Green, S. A., & Baker, B. L. (2012). Parenting stress and child behavior problems: A transactional relationship across time. American Journal on Intellectual & Developmental Disabilities, 117(1), 48-66. doi: 10.1352/1944-7558-117.1.48

Orme, J. G., & Buehler, C. (2001). Foster family characteristics and behavioral and emotional problems of foster children: A narrative review. Family Relations, 50(1), 3-15. doi: 10.1111/j.1741-3729.2001.00003.x

Scheeringa, M. S. (2011). PTSD in children younger than the age of 13: Toward developmentally sensitive assessment and management. Journal of Child & Adolescent Trauma, 4(3), 181-197. doi: 10.1080/19361521.2011.597079 

Statistisches Bundesamt. (2016). Statistiken der Kinder- und Jugendhilfe. Erzieherische Hilfe, Eingliederungshilfe für seelisch behinderte Menschen, Hilfe für junge Volljährige - Vollzeitpflege [Statistics of the child welfare services. Parenting assistance, integration of mentally disabled children, support of young adults - Foster Care]. Wiesbaden, Germany: Statistisches Bundesamt.

Reference article

Vasileva, M. & Petermann, F. (in press). Posttraumatic stress symptoms in preschool children in foster care: Influence of placement and foster family environment. Journal of Traumatic Stress

Discussion questions

  1. How can child welfare services and child psychotherapists better address the needs of traumatized young children in foster care and their foster parents?
  2. How can PTSS in foster care children be best diagnosed when foster parents often did not know the child before the trauma exposure and biological parents are not available or lack solicitude for the child?

Reference Article

Vasileva, M. and Petermann, F. (2017), Posttraumatic Stress Symptoms in Preschool Children in Foster Care: The Influence of Placement and Foster Family Environment. JOURNAL OF TRAUMATIC STRESS, 30: 472–481. doi:10.1002/jts.22217

Author Biographies

Mira Vasileva, M. Sc., is a doctoral student at the Center for Clinical Psychology and Rehabilitation in Bremen, Germany. She completed her master’s in clinical psychology at the University of Bremen. Her main research interests are psychopathology and resilience in trauma exposed-children as well as the relational impact of caregivers.

Franz Petermann, Ph.D., is a full professor of clinical psychology and psychological diagnostics at the University of Bremen as well as director of the University’s Center for Clinical Psychology and Rehabilitation in Bremen, Germany. His research focuses on diagnostics and therapy of developmental impairments and mental health problems of children and adolescents. Furthermore, he is intensively engaged with the development of psychological test batteries for children, adolescents, and parents. In the last 20 years, he published numerous recognized intervention and test batteries, consecutively being evaluated and optimized.