The psychosocial aspects of children exposed to war: Practice and policy initiatives. Journal of Child Psychology and Psychiatry, 45, 41-62

Yale Child Study Center, Yale University School of Medicine, New Haven, CT 06520-7900, USA.
Journal of Child Psychology and Psychiatry (Impact Factor: 6.46). 02/2004; 45(1):41-62. DOI: 10.1046/j.0021-9630.2003.00304.x
Source: PubMed


The atrocities of war have detrimental effects on the development and mental health of children that have been documented since World War II. To date, a considerable amount of knowledge about various aspects of this problem has been accumulated, including the ways in which trauma impacts child mental health and development, as well as intervention techniques, and prevention methods. Considering the large populations of civilians that experience the trauma of war, it is timely to review existing literature, summarize approaches for helping war-affected children, and suggest future directions for research and policy.

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    • "Interventionists should implement necessary treatment adaptations. More specifically, it is imperative to recognize factors that constitute the child's cultural world, including social relationships, community support, ontogenic beliefs, as well as religious practices and beliefs (Barenbaum et al. 2004). The impact of these cultural components must be examined across the child's life span, not simply from the period surrounding the traumatic event. "
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    ABSTRACT: Background This paper outlines conclusions from a three-day workgroup hosting the eight authors as well as others with expertise in the evaluation and treatment of youth exposed to war and violence. Objective The purpose of this meeting was to bring multiple perspectives together to identify components that comprise effective psychosocial interventions for child victims of war and community violence across cultures. The meeting also sought to identify gaps in the existing treatment approaches. Method In the meeting, personal experiences and previous research were discussed to develop a wide-ranging intervention approach, determine a cohesive definition for “indirect” exposure, and identify successful methods of intervention delivery for youth exposed to acts of war and violence. Results and Conclusions Key components of intervention for youth exposed to war/violence, important outcome measures, and cultural differences that may influence effective intervention were identified. A clearer definition of “indirect” exposure was also developed. Finally, a nine-phase model was developed to provide guidelines for establishing partnerships between trauma teams and other organizations or schools to implement and disseminate treatment for this population.
    Child and Youth Care Forum 08/2013; 42(4). DOI:10.1007/s10566-013-9203-4 · 1.25 Impact Factor
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    • "Evaluation of the effectiveness of interventions in war-affected, low-income countries is extremely challenging (Barenbaum et al., 2004), not least in the DRC, which is one of the least developed countries in the world. Concerns and constraints around safety, transport, finance, health, climate, time and sustainability could not have been surmounted without strong partnerships with local facilitators, advisors, community leaders and NGO staff. "
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    ABSTRACT: Background: The Democratic Republic of Congo (DRC) has been home to the world's deadliest conflict since World War II and is reported to have the largest number of child soldiers in the world. Despite evidence of the debilitating impact of war, no group-based mental health or psychosocial intervention has been evaluated in a randomised controlled trial for psychologically distressed former child soldiers. Method: A randomised controlled trial involving 50 boys, aged 13-17, including former child soldiers (n = 39) and other war-affected boys (n = 11). They were randomly assigned to an intervention group, or wait-list control group. The intervention group received a 15-session, group-based, culturally adapted Trauma-Focused Cognitive-Behavioural Therapy (TF-CBT) intervention. Assessment interviews were completed at baseline, postintervention and 3-month follow-up (intervention group). Results: Analysis of Covariance (ANCOVA) demonstrated that, in comparison to the wait-list control group, the TF-CBT intervention group had highly significant reductions in posttraumatic stress symptoms, overall psychosocial distress, depression or anxiety-like symptoms, conduct problems and a significant increase in prosocial behaviour (p < .001 for all). Effect sizes were higher when former child soldier scores were separated for sub-analysis. Three-month follow-up of the intervention group found that treatment gains were maintained. Conclusions: A culturally modified, group-based TF-CBT intervention was effective in reducing posttraumatic stress and psychosocial distress in former child soldiers and other war-affected boys.
    Journal of Child Psychology and Psychiatry 06/2013; 54(11). DOI:10.1111/jcpp.12094 · 6.46 Impact Factor
    • "This challenge to the universally distressful nature of political conflict is consistent with concerns of social scientists and psychiatrists about the tendency to exaggerate the prevalence of posttraumatic stress disorder. Collectively they note the Western orientation to individual psychology and its tendency to pathologize normative stress (Barenbaum et al., 2004; Becker, 1995; Gilligan, 2009; Summerfield, 2002; Ungar, 2004). Further challenges to the universality of distress in the face of adversity are the empirical findings of competent functioning in extreme contexts of various kinds (e.g., health adversities, severe personal grief, stress or trauma; see Almedom, 2005; Barber, 2009a; Westpahl & Bonanno, 2007; for reviews of these literatures), including the possibility that some even grow (i.e., past pre trauma adaptation; Tedeschi & Calhoun, 2004) from their conflict experiences. "
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    ABSTRACT: Aims and methodDrawing on empirical studies and literature reviews, this paper aims to clarify and qualify the relevance of resilience to youth experiencing political conflict. It focuses on the discordance between expectations of widespread dysfunction among conflict-affected youth and a body of empirical evidence that does not confirm these expectations.FindingsThe expectation for widespread dysfunction appears exaggerated, relying as it does on low correlations and on presumptions of universal response to adversity. Such a position ignores cultural differences in understanding and responding to adversity, and in the specific case of political conflict, it does not account for the critical role of ideologies and meaning systems that underlie the political conflict and shape a young people's interpretation of the conflict, and their exposure, participation, and processing of experiences. With respect to empirical evidence, the findings must be viewed as tentative given the primitive nature of research designs: namely, concentration on violence exposure as the primary risk factor, at the expense of recognizing war's impact on the broader ecology of youth's lives, including disruptions to key economic, social, and political resources; priority given to psychopathology in the assessment of youth functioning, rather than holistic assessments that would include social and institutional functioning and fit with cultural and normative expectations and transitions; and heavy reliance on cross-sectional, rather than longitudinal, studies.Conclusions Researchers and practitioners interested in employing resilience as a guiding construct will face such questions: Is resilience predicated on evidence of competent functioning across the breadth of risks associated with political conflict, across most or all domains of functioning, and/or across time? In reality, youth resilience amidst political conflict is likely a complex package of better and poorer functioning that varies over time and in direct relationship to social, economic, and political opportunities. Addressing this complexity will complicate the definition of resilience, but it confronts the ambiguities and limitations of work in cross-cultural contexts.
    Journal of Child Psychology and Psychiatry 02/2013; 54(4). DOI:10.1111/jcpp.12056 · 6.46 Impact Factor
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