Preventive interventions among children exposed to trauma of armed conflict: a literature review

Increasing research is available on the preconditions for child mental health and optimal development in traumatic conditions, whereas less is known how to translate the findings into effective interventions to help traumatized children. This literature review analyses the effectiveness of psychosocial preventive interventions and treatments and their theoretical bases among children traumatized in the context of armed conflicts (war, military violence, terrorism and refugee). The first aim is to evaluate the effectiveness of preventive interventions in preventing emotional distress and impairment and promoting optimal emotional‐cognitive and social development. The second task is to analyze the nature of the underlying mechanisms for the success of preventive interventions, and the theoretical premises of the choice of intervention techniques, procedures and tools. We found 16 relevant published studies, but an examination of them revealed that only four of them had experimental designs strong enough that they could be included in the meta‐analysis. While the subjective reports of the researchers suggested that systematic preventive interventions were effective in decreasing PTSD and depressive symptoms among children traumatized due to armed conflict, the more objective results of the meta‐analysis and the weaknesses in designs uncovered during the meta‐analysis undermine such a conclusion. Additionally, a majority of the reported preventive interventions focused only on children's biased cognitive processes and negative emotions, while only a few aimed at influencing multiple domains of child development and improving developmental functioning on emotional, social and psychophysiological levels. It is concluded that substantial additional work needs to be done in developing effective preventive interventions and treatments for children traumatized by exposure to war and violence. Aggr. Behav. 36:95–116, 2010. © 2009 Wiley‐Liss, Inc.     

Infants and Young Children in Military Families: A Conceptual Model for Intervention

Infants and young children of parents in the military deserve special attention because the first years of life are pivotal in establishing trusting attachment relationships, which are based on the developmental expectation that parents will be reliably available and protective both physically and emotionally. For young children in military families, the stresses of extended absences of mothers and/or fathers as the result of deployment abroad, recurrent separations and reunions resulting from repeated deployments, or parents struggling with the emotional sequelae of their war experiences, and the traumatic impact of parental injury and death can strain and derail the normative expectation of parental availability and protectiveness. This article describes the key features of mental health in infancy and early childhood, the developmentally expectable early anxieties that all children experience in the first years of life across cultures and circumstances, and the ways in which these normative anxieties are exacerbated by the specific circumstances of military families. The article also describes interventions that may be helpful in supporting military families and their children with the specific challenges they face.     

Children's understanding of the war in Iraq: views from Britain and Bosnia

Sixty‐one children (aged 9–17) from the United Kingdom (31) and Bosnia (30) were interviewed about the war in Iraq. Significant differences emerged in their views of the war. The Bosnian children were more affected by the Iraq War, more aware of who is involved in it, had different views about its causes, viewed the consequences of the war with greater gravity, and expressed a greater desire to end war and have peace. Two factors which might account for these differences – recent Bosnian history and the nature of media representations of the war in the two countries – are discussed.     

Unveiling the War Child Syndrome: Finnish War Children's Experiences of the Evacuation to Sweden During WWII from a Lifetime Perspective

During World War II, a total of 48,628 Finnish children were evacuated to Sweden and placed into temporary foster care. We studied the long-term effects of early separation among aging evacuees using a mixed-methods approach. The purpose was to understand how the evacuees experienced the evacuation event from a lifetime perspective and to determine the features of a possible war child syndrome. The evacuees expressed problems related to loss of confidence, detachment or rootlessness, and unworthiness or rejection. Feelings of rejection and unworthiness provoked shame in many of the reports. Our results suggest that support interventions should focus on processing these painful experiences.     

Is war a good or a bad thing? The attitudes of Croatian,Israeli, and Palestinian children toward war

It has been documented that children's basic attitudes to social issues such as war and peace are formed during the early school‐age period. The aims of the study were threefold: (1) to examine the attitudes of Croatian school‐age children toward war and peace; (2) to explore the relationship between these attitudes and children's gender, age, and amount of experience with war and violence; and (3) to compare the attitudes of Croatian children toward war and peace with the attitudes of Israeli and Palestinian children examined using the same scale 18 years earlier. The sample consisted of 230 children aged 11–14 years who attended school in Zagreb. The results indicate that Croatian children generally have a negative attitude toward war, but strongly support the fight for the freedom of their nation. A relationship was found between the children's gender, age, and war experiences and their attitudes toward war. A comparison between Croatian, Israeli, and Palestinian children showed that nationhood had an influence on attitudes toward war. However, there is greater similarity in the attitudes of today's Croatian and former Israeli children than between today's Croatian and former Palestinian children, and between Israeli and Palestinian children 18 years ago.     

The Promotional Role of School and Community Contexts for Military Students

This article examines how supportive public school environments can serve as a promotional context for the development of children and adolescents from military families. The authors integrate theory and research from multiple research strands (e.g., human development, studies of at-risk youth, educational reform, goodness of fit theory, and school climate) to outline how public schools can support the development of all children and adolescents. This article provides further support for the supposition that school climates and the social-ecological contexts surrounding a school (e.g., universities, communities, school districts) have the potential to protect at-risk children and adolescents from an array of negative social, emotional, and psychological outcomes. The authors draw linkages between these research domains and the development of military children and adolescents. Promotional civilian school environments embedded within supportive and inclusive contexts can create a social infrastructure that supports the development of military children and adolescents. The authors argue that this conceptual approach can create a foundation for interventions and research that focuses on schools as normative supportive developmental settings for military children and youth during challenging times of war (e.g., deployments and multiple school transitions). This article concludes with a discussion of future directions in research on the development of military children and adolescents. Based on a heuristic conceptual model that outlines areas needing further research, the authors call for a deeper theoretical and empirical integration of school climate and external contextual factors surrounding the school. Investigating the social and organizational dynamics within these contexts can result in a more comprehensive picture of the development of military children and adolescents.     

Pre-Conception War Exposure and Mother and Child Adjustment 4 Years Later

Evidence is accumulating for the transgenerational effects of maternal stress on offspring. A particular increasing concern is the possible transgenerational effects of community exposure to war and terror. Here, 107 mothers that had been exposed to war, were assessed with their 3 year old children (52 % girls) who had been conceived after the end of the war, and thus never directly exposed to war. The circumscribed nature (missile bombardment) and temporal limits (34 days) of the tragic 2006 Lebanon war in the north of Israel, affords a unique methodological opportunity to isolate an epoch of stress from preceding and subsequent normal life. We find that war experience engenders higher levels of mothers’ separation anxiety, lower emotional availability in mother-child interaction, and lower levels of children’s adaptive behavior. The novelty of these findings lies in documenting the nature and strength of transgenerational effects of war-related stress on offspring that were never exposed. In addition, because these effects were obtained after 4 years of a continuing period of normality, in which the children were born and raised, it suggests that an extended period of normality does not obliterate the effects of the war on mother and child behavior as assessed herein. Despite the study limitations, the results are indicative of persisting transgenerational effects of stress.     

Long-Term Trajectories and Service Needs for Military Families

The deployment of US military personnel to recent conflicts has been a significant stressor for their families; yet, we know relatively little about the long-term family effects of these deployments. Using data from prior military service eras, we review our current understanding of the long-term functioning and needs of military families. These data suggest that overseas deployment, exposure to combat, experiencing or participating in violence during war deployment, service member injury or disability, and combat-related post-traumatic stress disorder (PTSD) all have profound impacts on the functioning of military families. We offer several recommendations to address these impacts such as the provision of family-centered, trauma-informed resources to families of veterans with PTSD and veterans who experienced high levels of combat and war violence. Recent efforts to address the needs of caregivers of veterans should be evaluated and expanded, as necessary. We should also help military families plan for predictable life events likely to challenge their resilience and coping capacities. Future research should focus on the following: factors that mediate the relationship between PTSD, war atrocities, caregiver burden, and family dysfunction; effective family-centered interventions that can be scaled-up to meet the needs of a dispersed population; and system-level innovations necessary to ensure adequate access to these interventions.     

Consider the Children

Summary

In this article, we consider interventions for children exposed to family violence in light of the research on children's problems associated with witnessing family violence. Next, we review risk and protective factors related to these children's adjustment with the view that all children are not similarly affected by exposure to family violence. Against this background, we then move to consider directions for interventions from a systemic perspective. We take into account not only the exposure to interactions between their mother and father, but also children's relationships with their mother, father, and siblings, as well as within broader systems such as the peer group, the school, and the community. We consider the critical challenges within each of these important systems for children exposed to family violence, and we propose some potential interventions to address the problems. Finally, we summarize an evaluation of an intervention that incorporates some of the elements identified by a systemic perspective. The evaluation revealed a significant improvement in children's self-reports of depression and anxiety over the course of the program. Mothers rated their children as significantly improved in emotional and hyperactive behaviour problems. There was no relation between mothers' involvement in counselling and children's improvement. Overall, the results suggest that the Peer Group Counselling Program effectively provided support to children exposed to family violence. Finally, we discuss the steps necessary to support children and families in moving toward violence-free lives.     

The relationship between posttraumatic stress disorder symptoms and paternal parenting of adult children among ex-prisoners of war: a longitudinal study

The aversive impact of combat and combat-induced posttraumatic stress disorder (PTSD) on parenting of young children has been examined in a few studies. Nevertheless, the toll of war captivity on parenting and the long-term relations between posttraumatic symptoms and paternal parenting of adult children remains unknown. This longitudinal study examined paternal parenting of adult children among war veterans, some of whom were held in captivity. Furthermore, we examined the mediating role of PTSD symptoms in the association between captivity and parenting. The sample included two groups of male Israeli veterans from the 1973 Yom Kippur War: ex-prisoners of war (ex-POWs) and comparable veterans who had not been held captive. Both groups were assessed via self-report measures of PTSD at three time points: Time 1 (18 after the war), Time 2 (30 after the war), and Time 3 (35 after the war) years after the war. Results shows that ex-POWs reported lower levels of positive parenting compared to comparison group veterans at Time 3. Furthermore, PTSD symptoms at Time 1, Time 2, and Time 3 mediated the association between captivity experience and parenting at Time 3. In addition, it was found that increases in the levels of PTSD symptom clusters over time were associated with lower levels of positive parenting at Time 3.     

The spiritual meaning of war in the philosophy of the Russian silver age

The First World War forced the Russian intelligentsia to rethink its values—values that had been constructed in the nineteenth century. Distancing itself from pacifism and cultural relativism, it began to search for a moral meaning to the war that broke out in 1914—i.e. to defend the war as morally right and having a higher spiritual purpose. Russian philosophers were central to these debates, as they tried to interpret the war, and the relationship between war and peace, from a metaphysical point of view. The paper will look at philosophical, ethical and religious aspects of these debates, and some of the philosophers who participated in them.     

Interventions for children of divorce: toward greater integration of research and action.

A number of child-, family-, and system-focused interventions have been designed to prevent or reduce the negative effects of divorce on children. This article critically evaluates these intervention efforts by examining (a) their relation to basic research on the processes proposed to mediate children's postdivorce adjustment and (b) evaluation studies assessing the effectiveness of various programs. Although interventions address some of the factors proposed to mediate children's adaptation to divorce, the interplay between interventions and basic research on children's postdivorce adaptation is limited. Moreover, some intervention efforts appear to be beneficial, but most lack empirical documentation of their efficacy. This analysis leads to several recommendations for basic and applied research and for improving the response of the mental health field to the problems experienced by many children from divorcing families.     

Obstetric Autonomy and Informed Consent

I argue that public officials and health workers ought to respect and protect women’s rights to make risky choices during childbirth. Women’s rights to make treatment decisions ought to be respected even if their decisions expose their unborn children to unnecessary risks, and even if it is wrong to put unborn children at risk. I first defend a presumption of medical autonomy in the context of childbirth. I then draw on women’s birth stories to show that women’s medical autonomy is often ignored during labor. Medical interventions are performed during childbirth without women’s consent. Childbirth is risky and some coercive medical interventions may be understood as attempts to protect children and to prevent mothers from acting impermissibly. However, even if it is wrong to make risky choices during childbirth, women have rights to do wrong in these cases. Therefore, coercive medical interventions are impermissible during childbirth and institutions should adopt specific protections for obstetric autonomy.     

Business is not just war. Transferring the principle of double effect from war to business

Abstract

In this article the validity of transferring the Principle of Double Effect from the just war tradition to the domain of business is critically reviewed. If a case can be build for sufficient analogies between war and business, the principle of double effect can legitimately be transferred from war to business. If, on the other hand it can be shown that there are aspects in which business differ substantially from just war, then the transfer to business of a principle developed within the context of war becomes more problematic. After exploring the nature of arguments of analogy and fallacious arguments of weak analogy some important disanalogies between war and business are highlighted. Given these disanalogies it is then contended that the just war background of the Principle of Double Effect had some bearing on both the content and manner of application of the Principle of Double Effect. Finally it is argued that these disanalogies require some revisions to the Principle of Double Effect with regard to both its content and its manner of application before it can be applied meaningfully to foreseeable negative side-effects of business.     

Multicultural Issues in the Delivery of Group Interventions

Innovative preventive interventions are increasingly delivered in small group settings to children in school who are at risk for a variety of negative outcomes. In addition to reducing children's risk, these interventions present the possibility of enhancing students' awareness and understanding of cross-ethnic peers. To be effective with children from diverse ethnic backgrounds, these programs must examine their underlying assumptions regarding the definitions of social competence and methods of behavior change, tailor the program for each ethnic group served, and examine the impact of the interventions across different domains of the children's life.     

Melancholic Response to War Destruction and the Emergence of a Group Assumption of Post-Ness

What psychological response does war and forced displacement evoke in victims? How do survivors of war communicate their experiences to their children? Finally, what culture does the psychological response to loss shape? Using data collected through interviews, psychological consultations, and children’s drawings from two sources—the ongoing Syrian civil war and the Bosnian war of 1992–1995, this paper suggests that the experience of the war generation becomes the organizing axis of their identity and that of their children. It seeks to demonstrate that survivor parents communicate their experience of loss through gesture, act, and object rather than through a coherent narrative. Whereas survivor children use metaphoric and metonymic readings of their parents’ everyday performance in order to construct meaning and form their identities as descendants of a given family. This paper argues that such an identity is characterized by ambivalence towards the self and towards others, melancholic longing for an idealized pre-war past, and the impossibility of letting it go.     

Father Involvement in Parent Training for Oppositional Child Behavior

Outcome literature (1981 to 1988) on behavioral parent training interventions for nonhandicapped children with oppositional behavior is reviewed to assess the extent and effects of father involvement in parent training. Thirteen studies were found that included some father involvement. Weaknesses of these studies include a failure to observe and measure changed in father-child interactions, a lack of emphasis on the impact of the marital relationship, a lack of attention to similarities in parental child management strategies, and a lack of assessment of paternal characteristics. Further research to assess the effects of including fathers on parent training outcomes can improve the efficiency and effectiveness of these interventions.     

Mindfulness-Based Approaches with Children and Adolescents: A Preliminary Review of Current Research in an Emergent Field

Interest in applications of mindfulness-based approaches with adults has grown rapidly in recent times, and there is an expanding research base that suggests these are efficacious approaches to promoting psychological health and well-being. Interest has spread to applications of mindfulness-based approaches with children and adolescents, yet the research is still in its infancy. I aim to provide a preliminary review of the current research base of mindfulness-based approaches with children and adolescents, focusing on MBSR/MBCT models, which place the regular practice of mindfulness meditation at the core of the intervention. Overall, the current research base provides support for the feasibility of mindfulness-based interventions with children and adolescents, however there is no generalized empirical evidence of the efficacy of these interventions. For the field to advance, I suggest that research needs to shift away from feasibility studies towards large, well-designed studies with robust methodologies, and adopt standardized formats for interventions, allowing for replication and comparison studies, to develop a firm research evidence base.     

Innocent bystanders: Young children in war

Basic theoretical paradigms and constructs are identified within the extant literature that may usefully contribute to comprehending the effect of war upon young children as well as the nature of personal, situational, and familial moderating factors. These concerns are illustrated with empirical data regarding infants and toddlers and their response to the recent Gulf War. Potential applications of these heuristic models are explicated for the study of war as well as for the design of preventive and remedial programming.