by Cathy Glass
‘We haven’t decided yet.’
‘I think it would be good for her. Mixing with other children her own age will help her language and social skills, and also give you a break.’ She smiled kindly. Then to Anna she said, ‘Come on, let’s have a look at you, pet.’
The doctor listened to Anna’s chest, looked in her ears, eyes and throat, and then, showing her a card with brightly coloured objects on it, asked her to point to the correct one. ‘Dog,’ the doctor said. Anna pointed to it. ‘Ball.’ Anna pointed. ‘House,’ the doctor said, and Anna pointed to the correct object again. ‘Can you say “house”?’ the doctor asked.
‘House,’ Anna repeated.
‘She wouldn’t do that for me!’ Elaine said. ‘I knew she understood more English than she lets on.’
‘That’s children for you,’ the doctor said with a smile. The examination over, she returned to sit behind her desk. ‘Anna is fine, but I’ll make a referral for speech therapy to bring on her language skills. They are bound to be a bit behind those of children who have English as a first language. You’ll receive an appointment in the post within a few weeks. Once she is talking more, I think life will become easier for you both. If you have any more concerns, see me again. If necessary, I can refer her to the child psychologist, but I’m sure that won’t be necessary. Just give her time.’
‘Thank you. There is one more thing,’ Elaine said, embarrassed to ask.
‘Yes?’
‘I was wondering if you could prescribe a sedative for Anna to make her sleep at night?’
‘Why? Isn’t she sleeping?’
‘Yes, but she will only sleep in our bed.’
The doctor smiled. ‘Most children of her age would prefer to sleep in their parents’ bed if allowed. You will have to be firm to get her back into sleeping in her own bed. Does she have her own bedroom?’
‘Yes.’
‘Good. Establish a bedtime routine with a bath and story, then settle her in her own bed. Say goodnight and come out. If she gets out of bed, which she will do to begin with, take her back. You may have to return her many times until she learns, but she will learn. I’m speaking from experience. My son went through a phase of wanting to sleep with us. It took my husband and me a full week of taking him back before he learned.’ Elaine nodded politely, but didn’t dare say Anna had never slept in her own bed, not once. ‘Here are the names of some good websites that give parenting advice,’ the doctor said, winding up and passing her a printed sheet. ‘You use a computer?’
‘Yes. Thank you,’ Elaine said, tucking the paper into her bag.
‘You’re welcome.’
Elaine left the surgery, reassured by the referral for speech therapy, but aware that she and Ian were going to have to be firmer with Anna, although she wasn’t sure how. Perhaps the websites would help.
Four months later she returned in tears and begged that Anna be referred to a child psychologist. The situation had deteriorated further and, now aged three, Anna had been excluded from nursery for repeatedly hitting and biting other children.
PART II
Chapter Sixteen
Foster Care
‘Cathy, she has had two foster carers since coming into care a week ago,’ Jill said.
‘You’re joking!’
‘I wish I was. She can’t be moved again.’
‘No, indeed.’
Jill was my supervising social worker, also known as a support or link worker, from the agency I fostered for. It was early afternoon and Jill had telephoned me with some details of a five-year-old girl the social services wanted me to foster. It was shocking that the poor child had had to move twice since coming into care. It’s unsettling enough for a child to have to leave home to live with carers, without having to move carers – three times if she came to me.
‘What went wrong?’ I asked, aware that something must have happened to necessitate the moves.
‘The first carers were very experienced and were already fostering a baby. Anna kept trying to tip the baby out of its pram and cot. They had to watch her continuously and felt the placement had become unmanageable, so they asked for her to be moved. Although the second carers didn’t have young children, they were newly approved to foster and were horrified when Anna was cruel to their cat and kept throwing it downstairs. They tried sanctioning her but this morning, after another incident, they asked for her to be moved today.’
‘Jill, we have a cat,’ I said sombrely.
‘I know.’
‘At her age she should know it’s wrong to treat a baby or cat like that,’ I said, concerned. While a toddler might tip a baby out of a pram or throw a cat and not appreciate the significance or the harm they could do, a five-year-old certainly should know.
‘Anna has been diagnosed with Reactive Attachment Disorder,’ Jill said. ‘As you know from your foster carer training, it is thought to be responsible for a lot of behavioural problems.’
‘So she is seeing a child psychologist then?’
‘She has been, but not at present, although the school want a referral again. They have raised concerns about Anna’s behaviour since she started school, and she only attends part-time.’
‘Why part-time?’
‘She wasn’t coping. There were a number of incidents, so rather than exclude her, they have reduced her hours.’
‘Which school does she go to?’ Jill told me and I knew where the school was – on the other side of town.
‘We will need to move her later today,’ Jill said. ‘The only other carer we have free is newly approved. We can’t send her there.’
‘No, that’s for sure.’ Clearly Anna had very challenging behaviour so she needed to be placed with an experienced carer who would hopefully have the resources and strategies to manage and improve it. I was experienced but I was hesitating, because we’d just said goodbye the day before to a boy with very challenging behaviour. Was it fair on my children, Adrian, aged eight, and Paula, four, to look after another child straight away with similar or worse behaviour? Foster carers are expected to take the child referred to them unless there is a very good reason why they can’t. That I had just fostered a child with behavioural difficulties wasn’t sufficient reason to refuse; nor that I was a single parent and we had a cat.
‘Has she been in care before?’ I asked, hedging for time.
‘No. The social worker will fill you in on the details once you agree to take her. I do know that Anna is an only child and has generally been well cared for, although the parents sought help for her behaviour when she was about three – that’s when the psychologist was first involved. Ten days ago her mother telephoned the social services distraught and said she couldn’t cope with her any longer. Apparently her husband left them just after Christmas and Anna’s behaviour has deteriorated further since then.’
It was that piece of information that swayed me. I knew what it felt like to have your husband walk out, leaving you to face the future alone. The hurt and pain and crushing blow to your self-confidence. My husband had left me three years before (for another woman) and back then I had wondered how I would cope alone, then I found the resources. My children didn’t have behaviour problems, but without doubt, for a mother who was already struggling with her child’s behaviour, being left alone would be the final blow.
‘OK, what time will Anna be here?’ I asked. ‘I’ll need to collect Adrian and Paula from school later.’
‘I’ll find out and get back to you. Thanks, Cathy.’
Just to be clear, I could have refused to take Anna. Foster carers can’t be forced into looking after a child, but there is the expectation that they will. If I hadn’t taken her then very likely, rather than place her with inexperienced carers locally, the social services would have sent her out of the area for the care she needed. That would have created more disruption for the child, including a change of school or long car journeys to and from her present school. I hadn’t asked about contact arrangements; the social worker w
ould tell me later. Most children who come into care see their parents regularly. Neither had Jill told me what the care plan was – that is, the long-term plan for Anna – but from what I knew so far I assumed she would eventually be going home.
I went upstairs to check the spare bedroom, shortly to be Anna’s room, mulling over what I knew about Reactive Attachment Disorder (RAD). It is a rare but serious condition found in children who have never bonded with their parents or main caregiver, usually as a result of severe neglect or abuse, although that didn’t seem to be the case here – Jill had said Anna had been generally well looked after. RAD varies in severity and often becomes most noticeable around the ages of five and six, when the child’s already worrying behaviour spirals out of control. They often appear cold, uncaring and without conscience, remorse, empathy or trust, and are unable to form normal, loving relationships. They are angry, destructive, defiant, manipulative and cruel, and can steal and lie for their own ends, and appear not to care about the consequences. Name a negative behaviour and it will come up under Reactive Attachment Disorder, although some of these behaviours can be found in other conditions too. However, so great is the RAD child’s lack of emotion and conscience that on a brain scan there is a dark mass where their emotion should be. If left untreated, the condition can go with the child into adulthood, creating cold and calculating adults who show no remorse and are unable to form relationships.
The good news is that a child with RAD can improve dramatically with therapy, but in order to do so the child needs to be in a secure, stable and loving relationship with their parent (or main caregiver), which clearly Anna wasn’t.
I checked the bedroom. It was fine. Aware that it probably wouldn’t be long before it would be needed again, I’d changed the bedding and given it a good clean the day before, straight after the lad I’d been fostering had left. With 70,000 children in care in the UK and more coming in each day, there is a permanent shortage of foster carers and beds are never empty for long. As I neared the bottom of the stairs the phone rang. I answered it in the hall. It was Jill.
‘I’ve spoken to Anna’s social worker, Lori, and she will be going to collect Anna soon and will bring her to you. I’ve told her you need to pick up your children from school, so she will be with you when you get back around four o’clock. I’ll arrive ten minutes before.’
‘Thank you, Jill.’
‘If Lori needs to talk to you without Anna present, I’ll keep her amused in another room.’
‘Thanks,’ I said again. A good supervising social worker is invaluable in fostering. They know their carers and look out for them, offering support, advice and practical help when necessary. All I needed to do now was to tell Adrian and Paula that Anna would be coming to stay with us.
‘Good, a girl my age,’ Paula predictably said, viewing Anna as a playmate. She and her brother, Adrian, who was four years older, often played nicely together, but it’s a bonus to have someone of a similar age to play with.
‘OK,’ Adrian said with a shrug. We were walking from school. ‘But I need to watch something on television at five o’clock. Our teacher said we have to, it’s about the Tudors.’ This wasn’t as random as it sounded. Our television is in the living room, where the adults would be while Lori, Anna’s social worker, placed her, a process that Adrian knew would take an hour, or possibly longer.
‘I’ll set the recorder so you can watch it later,’ I said.
‘Why is she in care?’ Adrian asked.
‘I’m not sure of all the details but her mother was struggling with her behaviour and needed some help.’ A direct question deserved an honest answer, but I didn’t expand on this with talk about RAD and two carers unable to contain Anna’s behaviour. It could have worried Adrian and also prejudiced him (and Paula) against Anna. I would deal with her behaviour as it arose, although to be honest I wasn’t as confident as I might have sounded. Yes, I’d dealt with challenging behaviour before in children I’d fostered, but then it had been one of a number of concerns about the child; for example, a teenager who’d gone off the rails, experimenting with drink and drugs and getting into trouble with the police. To be fostering a child of five who’d had to leave her parents and two carers purely because of behaviour was a first for me.
Once home we just had time for a drink before Jill arrived. She said hello to Adrian and Paula and they disappeared up to their rooms to play. They’d come down when Anna and her social worker arrived. I made Jill a cup of coffee and we sat in the living room. As my supervising social worker, in addition to offering support and advice, she also attended meetings with me and was usually present when a child was placed.
‘Do we know any more about Anna’s background?’ I asked as she sipped her coffee.
‘No, because she’s been moved as an emergency the referral was sparse.’
I nodded. Had Anna come to me with more notice, as a planned move, I would have had more details and very likely Anna would have been able to visit us before the move, so we weren’t complete strangers to her. As it was, she’d meet us and see the house as she moved in, which wasn’t ideal but couldn’t be avoided. Jill and I chatted for a few minutes about another child I’d fostered a few years back and who was doing well. Foster carers are always pleased to hear news about the children they’ve looked after, even if it’s a long time ago. We never forget them.
Just after four o’clock the doorbell rang and I felt my heart step up a beat as I stood to answer it. I’m often slightly anxious before a new child arrives, wondering if they will like us, and what I will be able to do to help them, but I now had the additional worry of Anna’s behaviour.
Taking a deep breath, I opened the front door. ‘Hello, love, you must be Anna,’ I said with a smile, and wondered what all the fuss was about. Slightly built, with clear blue eyes and fair hair neatly trimmed to chin level, she looked as if butter wouldn’t melt in her mouth. Her gaze went past me and down the hall.
‘Hello, I’m Lori,’ her social worker said, coming in. We shook hands. In her late thirties, she was dressed smart-casual in a jumper and trousers and a warm winter jacket. ‘I’ll need a hand bringing in her cases later,’ she said.
‘Sure.’ It’s usual to get all the paperwork done first and then bring in the child’s belongs at the end, before the social worker says goodbye and leaves.
Lori automatically slipped off her jacket and hung it on the hall stand and left her shoes with ours.
‘Shall we take off your coat and boots?’ I said to Anna.
She looked at her boots as though considering this, then took off her coat, which I hung on the stand. ‘They’re nice warm boots,’ I said. ‘Leave them in the hall with ours.’ Which she did. We always take off our outdoor shoes when coming in for good hygiene, and I encourage others to do the same.
‘Jill’s here,’ I said to Lori. ‘Come through.’ I led the way down the hall and into the living room. ‘This is my supervising social worker, Jill,’ I explained to Anna.
‘Hi, Anna,’ Jill said with a smile. ‘How are you?’
Anna glanced at Jill but didn’t smile or acknowledge her in any way, just turned her head to look around the room. Jill and Lori said hello – they knew each other from working together before.
‘Do you want to play with the toys while we talk?’ Lori asked Anna, referring to the toy boxes I’d put out. Apparently she didn’t, for Anna went to the sofa and sat down. Lori sat beside her while Jill and I took the easy chairs.
‘Nice long garden to play in when it’s warmer,’ Lori said to Anna, glancing through the patio widows and trying to put her at ease.
‘Or if it snows,’ I said, hoping to capture Anna’s interest. She glanced at me but her face was expressionless and cool. I formed the impression she kept her feelings very well hidden, which could be part of RAD.
Having heard the doorbell, Adrian and Paula now came downstairs and I introduced them. Paula looked hopefully at Anna, wondering if she wanted to play, while Adrian l
ooked pointedly at the clock. ‘I’ve set the recorder for your programme,’ I told him.
Having said hi to Anna, he left – there was no need for him to stay; there’d be plenty of time for them to get to know each other later when the formalities were over. Paula was still looking hopefully towards Anna. Not only were they of a similar age, but a similar build too. ‘Would you like to play with Paula?’ I asked Anna.
‘No,’ Anna said. It was the first word she’d spoken.
‘OK, maybe later then,’ I said, and threw Paula an encouraging smile. She appreciated that when a child first arrived it could take a while for them to find the confidence to start playing and talking. Paula sat by the toy box and began taking out its contents as Anna watched. I didn’t think it would be long before she joined in.
‘Anna is in care under a Section 20,’ Lori began, adjusting the paperwork on her lap. ‘It was at her mother’s request.’ A Section 20 (of the Children’s Act) is also known as Accommodated, and is when a parent or parents ask for or agree to their child going into care voluntarily. There is no court case and they retain parental rights. ‘Anna has been diagnosed with an attachment disorder,’ Lori continued. ‘I haven’t read the full report yet but it’s thought it was a result of her early years’ experience. She was in and out of a state orphanage in –’ she named the country ‘– for the first two years of her life before she was adopted. We now know that the level of care in some of those orphanages was inadequate, and children were left for hours in their cots without any stimulation and their cries for help went unanswered. As a result, they can fail to trust adults or form loving relationships, and it comes out later in their behaviour.’
I saw Jill looking uncomfortably at Anna, as indeed I was. Lori was talking about her in quite personal detail in front of her. ‘Lori,’ Jill said, ‘would it be helpful for you to talk to Cathy about the history in another room? I can stay here with Anna and Paula.’
