A Life Course Study on Traumatic Brain Injury and Physical and Emotional Trauma in Foster Children

Abstract

Foster children are exposed to high levels of abuse, violence, and other adverse events throughout their childhood and adolescent years. Forms of brain injury, notably traumatic brain injury (TBI), are understudied in the foster child population. This study aimed to explore different forms of brain injury and their cognitive, behavioral, and psychological/emotional effects on current and former foster children using a life course perspective. A thematic analysis with a life course perspective was used to examine semi-structured, open-ended interviews conducted with current and previous foster children between the ages of 16 and 29 years. The study included 47 participants: 25 males (53%) and 22 females (47%) with an average age of 21 years and an average of 11.2 years of education. Of 47 current and previous foster children between the ages of 16 and 29, two-thirds had sustained one or more TBIs. Through a thematic analysis, four overarching and inter-related themes emerged from the data: frequent TBI, normalization (of abuse, violence, injury, and neglect), emotional trauma, and dangerous coping methods such as alcohol use in 94% and recreational drug use in 81%. Normalization of adverse events, emotional trauma, and the use of dangerous coping methods occurred in 66%, 81%, and 49% of participants, respectively, and are the cumulative toxic long-term effects of early negative life experiences and repeated forms of brain injury. Early and continued exposure to TBI, abuse, violence, and/or neglect with continued maladaptive behaviors suggests that the participants may have experienced changes in brain structure and function over their lives that provided the milieu for continued vulnerability to personal and future injury to future generations. These behavioral and perceptual changes point to a toxic combination of injuries that result in continued vulnerability to repeated injury through contextual exposure to risks and maladaptive normalization, emotional trauma, and risky coping styles.

Does binge drinking mediate the relationship between four adverse childhood experiences and adult traumatic brain injury? Results from the National Longitudinal Survey of Youth 1979 Cohort

“…And finally, protective adult relationships may help decrease the risk of adverse health behaviours and outcomes, including TBI, after ACEs 10 38. More research is needed to explore other social, biological and behavioural mechanisms that potentially mediate the pathways between ACEs and TBI, including brain development and functioning, socio-emotional functioning,8 exposure to community or other forms of violence15 and social and environmental conditions. Despite this, our results underscore the importance of integrating prevention and reduction of childhood adversity as part of comprehensive TBI prevention efforts 5…”

“…The relationship between substance use and ACEs may be related to a combination of developmental processes, low levels of parental monitoring, peer pressure, decision-making skills and high disinhibition during this time 12 14. For example, life course qualitative research among children in foster care found intersections between exposure to and normalisation of child adversity, and engagement in alcohol and recreational drug use as a coping strategy, which, in turn, was related with different forms of brain injury sustained throughout their lives 15…”