Pain-Based Behaviours in Foster Care: What’s Really Going On?

Pain-Based Behaviours in Foster Care: What’s Really Going On?

If you’re a part of a child’s care team, you’ve probably encountered behaviours that leave you feeling frustrated, confused or even hurt. Maybe a child lashes out when things don’t go their way, withdraws when you try and connect, or rejects your kindness no matter how much love you offer. It can feel personal.

But here’s the thing- it’s usually not.

These are what we call pain-based behaviours, and they’re a key concept in Therapeutic Crisis Intervention (TCI), developed by the RCCP Project at Cornell University. The idea is simple- when kids experience emotional pain but don’t have the words or coping skills to express it, that pain comes out in their behaviour.

For children in foster care, pain-based behaviours are incredibly common. Many have experienced neglect, abuse, instability or loss. They’ve been let down by adults before and, even if they don’t consciously think about it, their bodies and minds have learned to expect disappointment.

Shifting our perspective

Rather than labelling these behaviours as “bad” or “difficult”, we need to see them for what they really are; a child’s way of communicating distress. When we reframe our thinking, we can respond with compassion instead of frustration.

What do pain-based behaviours look like?

Pain doesn’t always look like sadness. In fact, it often looks like the opposite. Here are some common pain-based behaviours seen in children in care:

1. Aggression – lashing out physically or verbally as a defence mechanism.
2. Withdrawal – shutting down, avoiding eye contact, or isolating themselves.
3. Defiance and Control Battles – saying “no” to everything as a way to regain a sense of power.
4. Self-Harm – expressing emotional pain through physical means.
5. Hyperactivity and Attention-Seeking – acting out to get noticed or to distract from inner turmoil.
6. Running Away – fleeing from caregivers or situations when emotions feel overwhelming.

Why do pain-based behaviours happen?

At the root of these behaviours is a simple truth; hurt people, hurt people. Children in care have often been through tough situations that have left them feeling unsafe, powerless or unwanted. When those feelings bubble up, they show up as behaviours that might not make sense at first.

Another big factor? Survival instincts. If a child has spent years learning that adults aren’t safe or that love is temporary, they may push you away before you can leave them. It’s not logical; it’s protective.