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

Michael D Cusimano; Rachel Lamont; Stanley Zhang; Anamika Mishra; Melissa Carpino; David Wolfe

doi:10.1089/neur.2020.0054

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

Neurotrauma Rep. 2021 Mar 2;2(1):123-135. doi: 10.1089/neur.2020.0054. eCollection 2021.

Authors

Michael D Cusimano^{1

2

3}, Rachel Lamont¹, Stanley Zhang¹, Anamika Mishra¹, Melissa Carpino¹, David Wolfe⁴

Affiliations

¹ Injury Prevention Research Office, Division of Neurosurgery, Li Ka Shing Knowledge Institute, Keenan Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada.
² Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
³ Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
⁴ Centre for School Mental Health, Faculty of Education, Western University, London, Ontario, Canada.

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.

Keywords: childhood abuse; foster children; life course; normalization; trauma; traumatic brain injury.