Fostering Connections

Fifteen years ago, University of Oregon psychology professor Philip Fisher, MS '90, PhD '93, and his wife, a special education consultant, adopted a little boy from Oregon's child welfare system. David was a brown-haired, brown-eyed, three-year-old who loved cats and dogs and, according to Fisher, had the sweetest smile.

Like most adoptive parents, the couple believed they could help their son overcome his adverse infancy. During David's preschool and elementary years, his development was mostly on track—he was a bit slower to learn than his peers, but the Fishers helped him with his homework and hired tutors.

Approaching adolescence, David's struggles intensified. His friendships diminished. He had trouble remembering new vocabulary words. As soon as he learned a new math skill, he promptly forgot it. He had increasingly frequent disciplinary problems at school and became depressed. Despite the Fishers' expertise in child development and the efforts of a dedicated group of teachers and school administrators, friends and family members, no one seemed to be able to help David. Fisher searched for a therapist.

For years, this is the path he had been advising foster parents to follow in similar situations. But his own experiences proved disappointing—and enlightening. One of David's therapists recommended a family finger-painting exercise as a way to solve his apparent "bonding disorder," often a default diagnosis when behavioral issues arise. The therapist was so convinced this treatment would work that she volunteered to participate when Fisher and his wife refused. "She was supposedly an expert in helping adoptive families," Fisher says. "Like other therapists we had seen, she had no clear idea of what David and our family needed."

Fisher knew that the first three years of his son's life, like every child's early years, had been critical in terms of brain development. During this time, the proliferating neurons in babies' brains reach out and connect to other neurons. Both positive and negative experiences stimulate connections, which develop into neural networks. Underused connections die off in a process called pruning.

In simple terms, a child who receives loving parental attention will be more likely to develop neural networks associated with pleasure, while networks associated with occasional stress are pruned. Conversely, the brain of a neglected child will be predominantly wired for stress. "You don't need the child to be scarred with cigarette burns for things to go off-track," Fisher says. "It's not just about bad things happening, it's the absence of good things as well."

Because kids who end up in foster care often have been neglected, it's likely their brains have adapted to stress. Adaptations to chronic stress appear as cracks in a child's road to the future; kids who fall into them tend to be impulsive and socially insensitive, and often develop learning difficulties.

These children require especially clear signals to move forward, Fisher says, comparing their situation to driving on a 40-mile-per-hour thoroughfare. "They need a road sign with big letters every quarter mile: 40 mph. it's 40 mph. it's still 40 mph. don't forget it's 40 mph. They also need to know when it's curvy, when it's straight, when people are crossing."

Dangerous road conditions intensify at adolescence. From a brain development perspective, basic instincts kick in, like sex drive. But the part of the brain that involves self-control generally develops slowly in early stress victims. With hormones pushing teenagers into new behaviors and underdeveloped self-control mechanisms failing to provide an adequate counterbalance, these adolescents need even more support. "They don't want the road signs," Fisher says. Like most teens, "they want to figure it out themselves." The more support they get, the more they push away.

This is the point at which therapists often enter the scene, along with prescriptions for powerful psychoactive drugs to treat diagnoses of attention deficit hyperactivity disorder, psychoses, or bipolar disorder.

Instead of treating foster kids as mental health patients, Fisher and collaborators at Oregon Social Learning Center (where he works as a research scientist) view the children's behavior in terms of early adversity and brain development. In the mid-1990s, Fisher developed the Multidimensional Treatment Foster Care-P program (MTFC-P), a cost-effective regimen offering a different approach to helping young foster kids get their behavior back on track. In effect, MTFC-P teaches foster parents how and where to build road signs and teaches their kids how to read them. Fisher calls it "crash prevention."

The program places preschoolers for six to nine months with adults who have received training from psychologists like Fisher to notice and reward their child's positive behavior, avoid arguing with them, put them in time out, and calmly discipline them when they refuse to sit quietly on their own.

The results? MTFC-P children exhibited dramatically less antisocial behavior at home and during play dates than children who did not participate. Its effect was so dramatic that the British government recently integrated a similar program, called Adopt, into their social welfare system for adoptive families.

As Fisher repeatedly saw positive behavioral changes in MTFC-P children, he wondered what effect the program had on their neurological function. He tested three groups of five- to seven-year-olds: MTFC-P kids, similarly aged foster kids who did not participate in the program, and nonmaltreated peers. He compared peripheral brain activity (using electroencephalography, or EEG) when they played computer games, when they made mistakes while playing them, and when they were given instructions to avoid future mistakes.

Neurons in the prefrontal cortex of MTFC-P kids and the nonmaltreated kids showed more activity when the players learned how to avoid computer game errors, indicating that their brains were absorbing this information and putting it into action to prevent further mistakes. In contrast, non-MTFC-P foster kids showed very little brain activation, demonstrating that they were not processing instructions on how to avoid wrong choices.

Fisher explains: "If you are a teacher who says, 'Remember to raise your hand before blurting an answer,' and the child doesn't, you wonder why she isn't paying attention." She is processing the road sign as meaningless information. The 40 mph zone has turned into the autobahn.

In further experiments, Fisher and his doctoral student Alice Graham used functional magnetic resonance imaging (fMRI) to explore how infants process stress. At the UO's Lewis Center for Neuroimaging, they put sleeping six- to twelve-month-olds from high-conflict families in an fMRI scanner and played them sounds mimicking angry, mildly angry, happy, and neutral tones of voice.

The scanner measured brain activity in response to each sound. Their results demonstrated that babies from homes with the most domestic conflict (as reported by the mother) had the greatest response to angry speech tones. The scans showed increased levels of activity in the deeper areas of the brain that control emotions, stress reactivity, and stress regulation, Graham says. "Brain cells that fire together wire together," she explains. The research indicates that raised voices are enough to stimulate stress-related neural networks in infants. Most people think that babies are not absorbing a lot of what's going on in their environment, Graham says, but these findings offer a different picture.

For many families, bringing foster or adopted children into the home is a positive, life-transforming experience from start to finish. Others, like the Fishers, have navigated their way through their children's learning disabilities, often-difficult behaviors, and well-intentioned but uninformed therapists.

David will turn 18 next year and will face even more challenges as an adult. Fisher hopes his research helps kids like him reach their full potential and provides adoptive families with the support they need. "I want to reach out to them because I think there are a lot of them having similar experiences," he says.

Adoptive parents do not want to think about the behavioral challenges that may lie ahead when they bring their child home for the first time, Fisher says. "We all hope for the best." The best means raising healthy, well-adjusted children who mature into healthy, well-adjusted adults. It means keeping kids home, safe, and happy. It means everything to Fisher.

By Michele Taylor '10, MS '03