Q: I am a foster carer of a four year old who has experienced trauma and neglect. Do I have a role in drawing out the traumas that so obviously affect him? If so, how do I do it, or should I just wait for him to tell me?
Foster Carer from the South East

Dealing with trauma is very complicated and must be very carefully done. It is all too easy to re-expose the child to the trauma by talking about it. The child can then be left in a traumatised state, needing urgent professional help. Your main role as a foster carer is to provide your looked after child with a good, loving, stable environment. He will need good routines and clear boundaries. This is extremely valuable in helping him overcome all his difficulties arising from his past experiences.

Finding the reason for his difficulties is not always straightforward. If he is having some nightmares and/or flashbacks, along with disturbed mood and probably concentration difficulties, this may well be post-traumatic stress. His symptoms may get in the way of forming good attachments or his ability to learn in school. Neglect can also cause similar problems in areas such as attachment, learning, mood and concentration.

For you, as carer, it may not be necessary to diagnose the cause of his disturbed behaviour. It is more important to respond to your child if he does begin to talk to you about things. It is best for him to approach you, rather than you to try to 'draw him out'. You can help him do this by creating an atmosphere where he feels free to talk to you if he would like to do so.

However, children of this age may not want, or be able, to talk about their experiences. They may be better drawing or play acting. Look out for representational play. That is, the child makes up a story or uses toys to act out something that is emotionally similar to what has happened to him. For example, a child who has been present when parents have had violent fights, may represent that with pretend wars between his or her toys. But a note of caution here don't use play alone as an indicator of what has gone on for a child; even if he or she is playing soldiers a lot, it is not evidence that he or she has directly witnessed violence.

To encourage your child to feel free to talk to you, spend time doing things together which do not take too much concentration. Perhaps colouring, or doing a simple jigsaw. While you are doing this, chat with him a little about things that he may like talking about, such as the best thing that happened today.

When watching television together, talk about the programme and especially about how the characters feel for example, 'Jake probably felt really lonely when all the other Tweenies left him out of the game.' This will build up his own ability to understand and talk about feelings experienced by him and others - Tweenies included! Always make sure you tell him it was good to spend time with him, and make sure he realises you have heard and understood him.

If he freely talks about past trauma, then your task is to listen, without judging, and then help him cope with his emotions. Tell him that it is important that he has told you, and that he has been brave to do so. Make sure he knows that anything that happened is not his fault. Comfort him, if he is upset. Then it is vital that he is brought back to the here and now and not left in the middle of a flashback or a bad memory. Talk to him about how he is safe now, and how that was a long time ago. You can use what he knows to help him feel more secure - maybe there is a prayer you usually say with him, or a special routine or bedtime toy. Talk about some fun, safe things that you will be doing with him later.

As soon as you can, write down what he has told you, to give to his social worker. It may be needed later in court.

If your child is disturbed by what he has told you or is having bad nightmares, flashbacks (reliving the trauma as if he were there) or intrusive thoughts that interfere with his everyday life, then your role is to find him some professional help. Together with the therapist you will be able to assist him to overcome the effects of his past trauma.

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