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Children from infancy to 5 years of age entering the foster care system often have been living with one or more surrogate caregivers throughout most if not all of these years. These children present with a formidable array of internal and external vulnerabilities to their development. Constitutionally, a child may be at risk due to a high genetic predisposition, prenatal exposure to drugs, and/or pre- and perinatal insult. This strongly correlates with a highly sensitive nervous system, thus prolonged difficulty and confusion processing stimulation, attuning to a caregiver, and becoming regulated. Environmentally, a child may have difficulty due to separation from the natural caregiver in the first place and becomes more at risk with each subsequent disruption of placement. Environmental stressors such as a large number of children in the home, poverty, and systems issues, especially revolving around permanency goals, can impinge upon a child's capacity to experience and incorporate a safe, protected experience of being in the world.
On first blush the clincian may see disorganized, noncontingent behaviors manifested in hyperactivity, aggression, self-stimulation, or disassociative responses in the child referred for treatment. Closer inspection exposes the looming prospect of developmental psychopathology and in some cases imminent developmental failure. How can the clinician conceptually organize and therapeutically intervene in the lives of these children in an efficacious and economical manner?
The attachment relationship and the concomitant development of regulatory functioning constitute the cornerstone for understanding and organizing