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Helping Children Cope with Trauma: Individual, family and community perspectives

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Abstract

Helping Children Cope with Trauma bridges theory and practice in examining emerging approaches to enhancing resilience and treating traumatised children. Adopting a child-centred perspective, it highlights the importance of the synergy between individual, family, community and social interventions for recovery from post-traumatic stress.
... Having friends and feeling close to friends provide sources of emotional support for youth. Self-esteem, for example, may be enhanced when youth feel that their identity is respected and they belong to a group (Pat-Horenczyk, Brom, & Vogel, 2014). Peer relationships can also be an important source of coping skill acquisition, exposing youth to ways others cope and providing opportunities to implement coping skills as a group such as engaging in a particular problem-solving strategy. ...
... An explanation for the negative association between problem-focused coping strategies and mental health may be that without effective emotional regulation, trauma-affected children may employ harmful methods or behaviors employed to "fix a problem". For example, research suggests that without effective emotional regulation, trauma-affected children may exhibit increased aggressive behavior (Pat-Horenczyk et al., 2014). Furthermore, without use of emotion-focused coping, youth may lack the psychological strength to make a problem-focused strategy effective. ...
... Adults suffering from mental health disorders may not have the capacity to assist children and provide support (Belter & Shannon, 1993;La Greca, Silverman, Vernberg, & Roberts, 2002). Caregivers who are unable to be supportive to youth can result in increased distress and development of emotional suppression (Pat-Horenczyk et al., 2014), deficits in emotion understanding (Pears & Fisher, 2005) and less adaptive coping strategies (Compas et al., 2001). While the family environment impacted both boys and girl's well-being measures, these data suggest that girls are impacted more by their caregiver's PTSD than boys. ...
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This study tested a theoretical relationship between trauma exposure, youth coping strategies and peer, family and community level factors on psychological distress and well-being among 399 trauma-affected youth in the Democratic Republic of Congo. Structural equation modeling (SEM) was used to analyze paths and to assess differences in relationships by gender. Psychological distress was measured by self-reports of internalizing problems (depression and anxiety), externalizing problems (aggression and behavioral problems) and somatic complaints (pain without medical cause). Self-reports of happiness, hope and self-esteem were measures of well-being. Findings from this study suggest gender differences in how individual coping strategies and external factors explain mental health resilience in trauma-affected youth. Problem-focused coping strategies were associated with higher psychological distress in both boys and girls. Use of avoidance was associated with better well-being in girls and boys and use of faith-based coping strategies was associated with better well-being in boys. Use of both problem-focused and emotion-focused coping strategies (coping flexibility) resulted in lower psychological distress in boys and girls. The home environment including closeness to family, caregiver post traumatic stress disorder and violence in the home was associated with psychological distress and well-being. Having close peer relationships, village safety and enrollment in school benefited well-being. Results from these SEM of resilience suggest that interventions should (1) work to build the coping repertoire of youth, (2) support reduction in psychological distress through improved family relationships and caregiver mental health and (3) target improved well-being through support of positive peer and community relationships and school enrollment.
... Play encourages creativity by using the imagination. It is considered to be a therapeutic tool and an effective way of coping for children, especially those who have experienced trauma (Clark, 2016;Pat-Horenczyk et al., 2014;Ryan et al., 2017). Furthermore, play and playfulness are used in the clinical world, not only with children who have experienced trauma but also with elderly people (Monahan, 2015), adults (Bat Or & Megides, 2016), and families Tucker & Smith-Adcock, 2017). ...
Article
The objective of this study is to examine the role of imagination, playfulness, and creativity in healing or coping with trauma. A range of evidence-based trauma-focused treatments use imagination effectively, though often without theoretical references. This article provides an up-to-date, nonsystematic literature review, exploring the presented objective and focusing on the role of imagination in the treatment of posttraumatic stress disorder (PTSD). A computerized literature search, defined inclusion criteria, and synthesis aim to promote understanding in the field. We review brain overlaps pertaining to imagination and PTSD, presenting a hypothesis that the hippocampus and the default mode network play an important role in both. Creativity is presented as a significant predictor of resilience after traumatic exposure. Moreover, we discuss how resilience to, and coping with, a traumatic event is enabled by using playfulness. Finally, we discuss the gap between the frequent use of imagination in the treatment of PTSD and the lack of intended understanding of its mechanisms that bring about change. The fantastic reality model is presented as a theoretical and applied concept used in the utilization of imagination and playfulness to support therapeutic change. SEE FAR CBT protocol is presented as a therapeutic integrative approach that combines body and cognition, accommodating imagination and playfulness as sources of recovery. It interweaves imagination as part of the renarration of trauma, allowing wishful/fantastic elements to foster healing and promote resolution.
... The mothers tried to create a greater sense of safety for themselves and their children by utilising such strategies as overprotectiveness, control, hypervigilance and maintaining proximity. These responses suggest that, in many ways, these women are still functioning in the survival mode activated by long-term stressful situations (Brom, 2014), and have not fully readjusted to safer surroundings once the stressful events subsided. Thus, responses characteristic of the survival mode, such as hypervigilance, difficulty regulating emotions and avoidance of risks, are still present and affect their parenting behaviour. ...
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Mothers living in areas exposed to ongoing military conflict are at higher risk for psychological difficulties, such as posttraumatic stress disorder, than those not living in such areas. The aim of this two‐part exploratory study was twofold. The first aim was to examine differences between mothers who grew up under ongoing military conflict in childhood and mothers who did not grow up in affected areas in terms of their levels of differentiation of self and parental self‐efficacy (PSE). The second aim was to identify and describe the parenting experiences of mothers who were exposed to military conflict in childhood. In Part 1 of the study, the sample included 120 mothers (half of whom reported on being exposed to ongoing military conflict in childhood). Findings showed that mothers exposed to ongoing military conflict in childhood reported lower levels of differentiation of self and PSE than their counterparts. In Part 2, 10 mothers who were exposed to ongoing military conflict as children were interviewed about their experience as parents and their PSE. Results indicated that the mothers felt their childhood experiences affected their parenting and PSE negatively, resulting in anxiety, difficulty dealing with stress and sometimes posttraumatic symptoms as well as parental patterns of overprotectiveness, separation anxiety and intergenerational transmission of anxiety. The results highlight the consequences of exposure to ongoing military conflict during childhood on levels of differentiation of self and parenting practices.
... Historic traumatic events, themselves, are not directly transmitted across generations from survivors to future generations of children (Pat-Horenczyk, Brom, & Vogel, 2014). Instead, an altered environment (i.e., of disrupted family, community, and sociocultural norms) is transmitted from generation to generation, which in turn has the potential to disrupt children's development and increases their immediate and long-term risk for poorer mental and physical health. ...
Article
This paper argues that intergenerational trauma undermines the rights of the child, as per articles of the United Nations Convention on the Rights of the Child. To meet this objective, this paper draws on the available evidence suggesting that intergenerational trauma deprives children of their rights to environments free of maltreatment-abuse (Articles 19), and poverty (Article 27), in addition to undermining their rights to their own culture (Article 30). This paper then draws on available intergenerational trauma research, suggesting that child maltreatment-abuse, poverty, and loss of culture prevent the child from obtaining the best possible health, with the latter also a right outlined in Article 24. Because this paper argues that the study of intergenerational trauma owes its existence to political movements, recommendations are made for researcher engagement in multisectorial child-centric research initiatives, in order to help realize children’s rights that are undermined by intergenerational trauma and improve children’s health.
... Whilst some cognitive emotion regulation strategies are adaptive, some are maladaptive [21]. Negative cognitions about the self, the world, self-blame and catastrophizing, for example, have been associated with the PTSD symptom of negative alterations in cognitions and mood; catastrophizing is also associated with the re-experiencing symptoms [22]. ...
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This study examined 1) the relationship between posttraumatic stress disorder (PTSD) from past trauma, interpersonal sensitivity and psychiatric co-morbidity, and 2) whether cognitive emotion regulation strategies would mediate the impact of PTSD on specific distress outcomes. Four hundred seventy-five Kazakh students (F = 336, M = 139) participated in the study and completed a demographic page, Posttraumatic Stress Diagnostic Scale for DSM-5, General Health Questionnaire-28, Interpersonal Sensitivity Measure and Cognitive Emotion Regulation Questionnaire. The results showed that 71% reported that they had experienced at least one trauma throughout their lifespan, of whom 39% met the criteria for full-PTSD. Controlling for age and university majors, PTSD was associated with interpersonal sensitivity and psychiatric co-morbidity. Cognitive emotion regulation strategies were correlated with specific distress outcomes. Whilst positive reappraisal and refocusing on planning were associated with interpersonal sensitivity, self-blame and putting the trauma into perspective were associated with psychiatric co-morbidity. Self-blame mediated the impact of PTSD on psychiatric co-morbidity. To conclude, trauma can heighten levels of sensitivity in interpersonal interaction and psychological symptoms. Having specific thoughts about the trauma can impact on specific psychological reactions. Blaming oneself for the trauma can influence its impact on the severity of psychological symptoms.
Article
Increasing rates of posttraumatic stress disorder (PTSD) in military populations during recent conflicts have sparked concerns regarding the incidence of other commonly associated problems, such as intimate partner violence (IPV). From a clinical perspective, it is important to understand patterns of PTSD symptomology that may indicate heightened risk for such aggression. To address this, among a longitudinal cohort of U.S. military personnel, we evaluated the association of PTSD symptom clusters and comorbid conditions as predictors of any subsequent Department of Defense Family Advocacy Program incidents of IPV meeting full definitional criteria for physical or psychological abuse. Results suggested that general symptoms of negative affect common in PTSD (e.g., anger/irritability, sleep disruption) and comorbid alcohol dependence were stronger predictors of IPV than trauma-specific PTSD symptomology (e.g., reexperiencing, hypervigilance). Clinical implications and recommendations for future research are discussed.
Article
In situations of cumulative trauma, it is often unclear why some people remain resilient, whereas others experience distress, and how likely these responses are to change over time. To investigate the constancy of responses to cumulative trauma, stability and change in posttraumatic distress and resistance (as defined by no evidence of clinical symptoms) were assessed twice in 140 Israeli children and mothers exposed to continual rocket attacks over approximately 7 years, when the children were 2–4 (Time 1) and 9–11 years of age (Time 2). Measures included trauma exposure, posttraumatic and depressive symptoms, and child behavioral problems. We identified 4 longitudinal courses (LCs): resilient (resistance at Time 1 and Time 2), recovered (clinical distress at Time 1 and resistance at Time 2), developed symptoms (resistance at Time 1 and clinical distress at Time 2), and chronic distress (clinical distress at Time 1 and Time 2). Results showed more stability than change in the frequencies of resistance at both times of measurement. The resilient LC was the most common longitudinal course for both mothers and children. Multinomial regression models indicated that maternal posttraumatic symptoms predicted the recovered and chronic distress LCs of the children.
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Children's talent to endure stems from their ignorance of alternatives. (Maya Angelou, 1969). INTRODUCTION. A central tenet of contemporary developmental psychopathology is that our understandings of normative and abnormal development mutually inform one another (Cicchetti, 1990, 1993; Cicchetti & Cohen, 1995; Sroufe & Rutter, 1984). Historically, however, research has focused on the determinants of psychopathology and maladaptation to the relative exclusion of elucidating factors that contribute to the initiation and maintenance of adaptive developmental pathways. More recently, a strong and growing literature has emerged identifying factors that enable individuals to achieve adaptive developmental outcomes despite adversity. The study of risk and resilience derived from the observation that some individuals in populations exposed to incontrovertible adversity nevertheless achieve adaptive developmental outcomes (e.g., Garmezy, 1974; Murphy & Moriarty, 1976; Rutter, 1979; Sameroff & Seifer, 1983; Werner & Smith, 1992). These individuals exemplify resilience, “the process of, capacity for, or outcome of successful adaptation despite challenging or threatening circumstances” (Masten, Best, & Garmezy, 1990, p. 426). Over the past 25 years, research on a variety of at-risk populations has identified factors that moderate the relation between risk and competence, namely, protective and vulnerability factors (Masten & Coatsworth, 1998). More recently, however, increasing attention has been directed toward identifying and refining the methodological and theoretical frameworks within which resilience is conceptualized and studied in order to clarify the processes that underlie adaptive development in the context of adversity (e.g., Luthar, Cicchetti, & Becker, 2000; Sameroff, 2000).
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Vietnam combat veterans with post-traumatic stress disorder (PTSD) were compared to non-combat Vietnam era veterans without PTSD on their perceptions of their children's social and emotional functioning. A total of 107 veterans completed a parent's behavior checklist on their 191 children. The results indicated that fathers with PTSD perceived their children as exhibiting a substantially greater degree of dysfunctional social and emotional behavior. The types of dysfunctional behaviors were a function of the child's age and sex; however, children of PTSD fathers were generally rated as significantly more likely to exhibit an inadequate level of self-control resulting in various externalizing problem behaviors such as aggression, hyperactivity and delinquency. Further, these children were perceived as having difficulty establishing and maintaining friendships. The findings support the notion that a father's anxiety disorder, such as PTSD, may be related to his children's social and emotional functioning.
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In this chapter, we describe the major developments in the field of resilience since its inception more than 40 years ago. The chapter is organized in four sections, the first one presenting a brief history of work on resilience. The second section is devoted to elucidating critical features of research on this construct, highlighting three sets of issues: definitions and operationalization of the two constructs at its core, protective and vulnerability factors; distinctions between the construct of resilience and related constructs, such as competence and ego resiliency; and differences between resilience research and related fields, including risk research, prevention science, and positive psychology. The third section of the chapter is focused on major findings on vulnerability and protective factors. These are discussed not only in terms of the specific factors found to modify risk within three broad categories--attributes of the family, community, and child--but also in terms of factors that exert strong effects across many risk conditions and those more idiosyncratic to specific risk contexts. The final section includes a summary of extant evidence in the field along with major considerations for future work on resilience across the life span. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The authors note the lack of attention to issues of cultural diversity in disaster-related research, and review the limited studies available. The authors provide interesting and important ideas for incorporating diversity-related concepts (e.g., acculturation stress, cultural beliefs and customs, kin networks) into future research efforts with diverse populations. Given the limitations of the current literature, the authors have three goals for this chapter. The first is to provide an overview of socioeconomic status and social support, two factors that may be relevant to ethnically diverse samples. The authors also propose that culture may serve as either a risk or a protective factor. A second goal is to summarize several studies of disasters among ethnically diverse, hurricane-exposed, American children to provide a background for how ethnicity might interact with risk and protective factors to affect the development of posttraumatic stress disorder (PTSD) in children. Finally, they use the example of American Indian youth to demonstrate the need for further empirical investigation of cultural variables as potential risk and protective factors for PTSD. The authors close the paper with suggestions for future directions in research and clinical practice. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Early development may be described in terms of a series of salient issues (regulating arousal, establishing an effective attachment relationship, moving toward autonomous functioning, establishing peer relations). The quality of individuals' functioning with respect to these issues may be assessed reliably. Such qualitative assessments yield strong predictions of later behavior. Children functioning well during the infancy period are more competent as toddlers and preschoolers, and there is a logic and coherence to the continuing pattern of adaptation shown by individuals. In various ways such continuity has been shown to be independent of IQ or temperament variation. Such continuity once again makes clear the importance of early experience and the need to examine public policy in light of this knowledge. (20 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Describes a representative sample of Jewish families with at least 1 member who survived the Holocaust—in the underground, by hiding, or in ghettos or work or death camps—and with 1 or more children born after the war. Data were obtained in clinical work with survivors and offspring participating in a group project in the New York City area begun in 1975. Approximately 50 survivors, aged 37–74 yrs, and 200 children of survivors, aged 17–33 yrs, were interviewed. Factors involved in the re-formation of survivor families, the "conspiracy of silence" or refusal to talk about camp experiences, psychological traits of those survivors who later adopted the role of either a "victimized Jew" or a "fighter," the effects of these roles on the families, and the importance of understanding an individual survivor's war history are examined. The most painful struggle underlying survivors' attempts at coping with and integrating the impact of the Holocaust into the lives of the families is the impossibility of mourning. (54 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The trauma field must develop theories and methods that are capable of describing a range of adaptive and maladaptive posttraumatic adjustment trajectories, predicting which subgroups are at risk for moving into specific adjustment trajectories, explaining the configurations and causal pathways through which beneficial and adverse causal factors intersect to influence the course of posttraumatic adjustment; and guiding wellness-oriented interventions to maximize the proportion of trauma-exposed groups that enter adaptive posttraumatic adjustment trajectories. Accordingly, this chapter will address four basic questions: (1) What configurations are adverse and beneficial life events and circumstances likely to form as they intersect and combine to influence wellness-related outcomes in populations at risk for various forms of trauma exposure? (2) What common adaptive and maladaptive posttraumatic adjustment trajectories may trauma-exposed individuals enter as the joint consequence of their trauma exposure and the adverse (e.g. vulnerability) and beneficial (e.g. protective) factors that make up their surrounding ecological contexts? (3) What specific attributes of beneficial resources may influence the degree to which they help individuals to cope with specific types of trauma or other major adversities? (4) What constellations of beneficial and adverse causal factors make up the life caravans of individuals who exhibit similar posttraumatic adjustment trajectories? In responding to these questions, we first unpack five content domains relevant to designing wellness-oriented public health interventions, and then integrate these strands in clinically and theoretically informative ways. We then draw on Conservation of Resources (COR) theory (Hobfoll 1988, 1998) to illustrate the implications that interweaving these five elements holds for designing and implementing wellness-oriented interventions. Our aim is to assist in laying the groundwork for a general wellness-oriented public health approach to intervention across a diverse range of trauma types and severe hardships, an approach that places high priority on prevention, the accurate identification of at-risk subgroups, and effective early intervention with subgroups deemed at high risk. We hope that this framework will serve as a heuristic tool that stimulates further research and intervention-related applications. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The present study examines the contributions of (1) parental socialization of emotion and preschoolers' emotional interaction with parents to their emotional competence, and (2) parental socialization and child emotional competence to their general social competence. Both observational and self-report techniques were used to measure emotion socialization, emotional competence, and social competence of preschoolers (average age = 49.8 months) from 60 middle-socioeconomic-status families. Data were collected in both classroom and home settings. In general, the results suggest that parental modeling of expressive styles and emotional responsiveness to child emotions are important predictors of preschoolers' emotional competence and their overall social competence. Children whose parents were more affectively positive tended to display more positive emotion with peers, whereas children whose parents were more negative appeared less socially competent in the preschool. Parents who were better coaches of their children's emotions had children who understood emotions better. Age and sex moderated several of the study's key findings. The results are consistent with earlier research indicating that parental socialization of emotion impacts the child's emotional and social functioning both at home and in the preschool.
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A school-based study conducted in 1990, 1 year after Hurricane Hugo, investigated the frequency and correlates of post-traumatic stress disorder (PTSD) in 1,264 adolescents aged 11-17 years residing in selected South Carolina communities. Data were collected via a 174-item self-administered questionnaire that included a PTSD symptom scale. A computer algorithm that applied decision rules of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised to the symptoms reported was used to assign a diagnosis of PTSD and to designate the number of individuals who met the reexperiencing (20%), avoidance (9%), and arousal (18%) criteria. Rates of PTSD were lowest in black males (1.5%) and higher, but similar, in the remaining groups (3.8-6.2%). Results from a multivariable logistic model indicated that exposure to the hurricane (odds ratio (OR) = 1.26, 95% confidence interval 1.13-1.41), experiencing other violent traumatic events (OR = 2.46, 95% confidence interval 1.75-3.44), being white (OR = 2.03, 95% confidence interval 1.12-3.69) and being female (OR = 2.17, 95% confidence interval 1.15-4.10) were significant correlates of PTSD.
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The devastating effects of traumatic events on children are modulated by risk and protective factors. This study examines the differential effects of traumatic displacement of preschool children and their families following Scud missile attacks on Israel during the Persian Gulf War. Three groups participated in the study: families displaced after their houses were damaged, undisplaced families from the same neighborhood (without home damage), and families from a distant city that was threatened but not directly attacked. Data concerning the traumatic event, the child (personality, internalizing, externalizing, and stress symptoms), the mother (Symptom Checklist-90-Revised), and the family (Family Adaptability and Cohesion Evaluation Scales) were gathered 6 months after the end of the war. Displaced children and mothers showed higher externalizing and stress symptom levels compared with undisplaced and threatened subjects. Destruction of the house and displacement, but not mere distance from the missile impact, explained symptomatic behavior. Inadequate family cohesion predicted symptomatic reaction for 3- and 4-year-old children but not for older ones. Both human and nonhuman factors contribute to the preschool child's adaptive mechanisms that regulate environmental stressful stimuli. These risk-modifying factors become more autonomous of caretakers with increasing age.
Article
Research is needed to further deconstruct and define the neurobiological substrates of specific components of self-regulation in relation to early childhood trauma-related PTSD. Brain activation patterns related to dissociation have been investigated preliminarily 21,31 and similar studies are needed to provide greater specificity than that provided by categorical diagnoses (eg, PTSD). Self-regulation can provide a basis for theoretical models and interventions that focus on posttraumatic resilience. 31 Future success in developing effective treatments for children and adults who experience complex biopsychosocial impairments following exposure to early life DAIT depends upon continued dialogue between scientists and clinicians who share a focus on the nature, neurobiology, and development of affective and cognitive self-regulation.
Article
The authors used an integrative conceptual model to examine the emergence of posttraumatic stress disorder (PTSD) symptoms in 568 elementary school-age children 3 months after Hurricane Andrew. The model included 4 primary factors: Exposure to Traumatic Events, Child Characteristics, Access to Social Support, and Children's Coping. Overall, 62% of the variance in children's self-reported PTSD symptoms was accounted for by the 4 primary factors, and each factor improved overall prediction of symptoms when entered in the analyses in the order specified by the conceptual model. The findings suggest that the conceptual model may be helpful to organize research and intervention efforts in the wake of natural disasters.
Article
This study investigated the role that social support plays in posttraumatic stress (PTS) and depressive symptoms among Israeli adolescents with high or low exposure to terrorist acts. Participants were 585 Jewish students (221 girls and 364 boys) in grades 7 to 12 from areas extensively versus slightly exposed to terrorist attacks. Results found that PTS levels and depressive symptoms were higher among adolescents residing in areas highly exposed to terrorism. Adolescents in high exposure areas reported lower perceived levels of support than adolescents in low exposure areas when gender, age, and religiosity were controlled. Social support was found to be a significant predictor for PTS and depressive symptoms, but no evidence for a buffering role of social support was obtained. We conclude that social support has a positive effect on a person's mental health regardless of the type and level of the stressor the individual is exposed to.
Article
In this chapter we review existing knowledge about the development of infants whose parents have mental illness. We begin with a brief review of the general long-term consequences of having a parent with mental disorder. Included in this discussion are theoretical models of intergenerational transmission of illness, identification of parents, and general methodological issues in this area of research. The main sections of the chapter review major developmental processes in infancy with findings specific to children born to mentally ill women. A summary and integration conclude the chapter. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Examined M. Main and E. Hesse's (1990) theory that frightening behavior is the causal link between unresolved loss and infant disorganization/disorientation. The home behavior of 11 low-risk mothers was observed when their infants were 10 or 11 mo old. The Adult Attachment Interview (C. George et al; 1984, 1985, 1996) was conducted with the mothers when the infants were about 12 mo old. When the infants were approximately 14 mo old, the strange situation procedure (M. D. S. Ainsworth and B. A. Wittig, 1969) was administered. Case descriptions were organized according to 4 classifications of maternal state of mind regarding trauma, maternal behavior at home, and infant strange situation behavior: concordance with unresolved loss, concordance with no unresolved loss, disconcordance, and a mother who had recently experienced a loss of a loved one when her home behavior was observed. In support for Main and Hesse's theory all unresolved mothers displayed frightening behavior and most of these infants were classified as disorganized, and there were no children classified as disorganized in the group of children whose mothers who were not disorganized. However, frightening behavior was also found in 3 mothers without unresolved loss and their infants were not disorganized. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Investigates literature that seeks to identify "protective" factors that seemingly enable individuals to circumvent life stressors. These factors include the dispositional attributes of the individual, family affectional ties, and external support systems. The patterns of high achievers include frequent school contact initiated by parents; the child's exposure to stimulating, supportive school teachers; and infrequent family conflict. The attributes of competent, Black disadvantaged children include social skills, a self-perception founded on a sense of power rather than powerlessness, and cognitive skills and styles that differentiate them from their less competent peers. Schools that enhance cognitive and social competence show concern with academic and work-oriented goals, express appreciation of good work, and maintain a prosocial atmosphere. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
The objectives of this chapter are to describe the legacy of combat trauma on the children of Vietnam veterans and to identify the mechanisms through which these cognitive, affective, and behavioral patterns are handed down. In addition, the chapter explores issues of how to determine if, when, and how to intervene. Case examples of the messages Vietnam veterans can pass on to their children are presented. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Standard nosologies of psychiatric disorders have made preliminary efforts to accommodate developmental differences in symptom manifestation by young children. Significant gaps remain in the validation of disorders for this age group. The DC: 0–3 represents an alternative nosology for disorders of infancy that attempts to complement existing approaches and assist clinicians and researchers. In this commentary we review research on two disorders of early childhood—Posttraumatic Stress Disorder (PTSD), and Reactive Attachment Disorder (RAD)—to illustrate the promises and problems of the DSM-IV and DC: 0–3 approach to definition and conceptualization of these disorders. In addition we review what is known about RAD and PTSD with regard to key areas of controversy in early childhood psychopathology: (1) continuous versus categorical conceptualization, (2) developmental considerations, and (3) the relationship context. Recommendations are made for future editions of the DSM-IV and DC: 0–3, as well as for validity research in early childhood disorders. ©2003 Michigan Association for Infant Mental Health.
Article
Examined the interaction of individual and environmental characteristics over time in children from maltreating families in order to explore the origins, scope, and stability of resilience in children from abusive and neglectful home environments. 457 children (aged 18 mo–6 yrs) and their families were studied longitudinally from 1976 to 1992. In the late adolescent follow-up phase in 1990 to 1992, 23 of 25 children identified as resilient (i.e., functioning at a level higher than expected given their troubled family situations) were reassessed. These Ss were interviewed to assess their school status, work history, peer relationships, and history of academic and social accomplishments and difficulties. Response to supportive influences in the extended family and wider community, as well as determination to be different from abusive parents, was identified as being crucial to resilient behavior. A case study is provided.
Article
Fraiberg and her colleagues (1975) introduced the metaphor “ghosts in the nursery” to describe the ways in which parents, by reenacting with their small children scenes from the parents' own unremembered early relational experiences of helplessness and fear, transmit child maltreatment from one generation to the next. In this article we propose that angels in the nursery—care-receiving experiences characterized by intense shared affect between parent and child in which the child feels nearly perfectly understood, accepted, and loved—provide the child with a core sense of security and self-worth that can be drawn upon when the child becomes a parent to interrupt the cycle of maltreatment. We argue that uncovering angels as growth-promoting forces in the lives of traumatized parents is as vital to the work of psychotherapy as is the interpretation and exorcizing of ghosts. Using clinical case material, we demonstrate the ways in which early benevolent experiences with caregivers can protect against even overwhelming trauma, and examine the reemergence of these benevolent figures in consciousness as an instrument of therapeutic change. Finally, we examine implications of the concept of “angels in the nursery” for research and clinical intervention.
Article
This review of the literature reveals that veterans' posttraumatic stress disorder (PTSD) following exposure to combat violence affects veterans' familial relationships and the psychological adjustment of family members. Previous study within other trauma populations has conceptualized the negative impact of an individual's traumatic stress on his/her family members as “secondary traumatization.” This review examines the processes by which secondary traumatization occurs within combat veterans' families. Research has identified PTSD as mediating the effect of veterans' combat experience on the family. Veterans' numbing/arousal symptoms are especially predictive of family distress; while, to a lesser extent, veterans' anger is also associated with troubled family relationships and secondary traumatization among family members. Empirical modeling of additional factors involved in secondary traumatization is needed. Marital/family interventions have largely focused on improving relationships and reducing veterans' symptoms, rather than targeting improvements in the psychological well-being of the spouse and children. Interventions directly addressing the needs of significant others, especially spouses, are advocated. The potential for increased effectiveness of PTSD interventions and possible cost-savings attained by improving relationships and reducing caregiver burden are also discussed.
Article
The authors examine the role of appraisal and social support as mediators of the relation between control beliefs and adaptive behavioral outcome. Using the responses from 297 children, ages 8 to 12 years old, the results suggest two significant mediational pathways. Social support was a mediator of the relation between unknown control for negative events and adaptive behavior and the relation between unknown control for positive events and adaptive behavior. Negative appraisal demonstrated no mediation relations. The role of social support and negative appraisal in the display of adaptive behavior and the implications for further model testing are discussed.
Article
Protective processes in at-risk children between 4 and 13 years of age were examined in a longitudinal study. A multiple risk index was used at 4 years to identify 50 high-risk children and 102 who were at low risk. Cognitive and social-emotional status were measured at each time point. The following indicators of protective processes were related to positive change in cognitive and/or social-emotional function in the high-risk children between 4 and 13 years: mother-child interaction; child perceived competence, locus of control, life events, and social support; and maternal parenting values, social support, depression, and expressed emotion. Many of these factors were also related to improvement in the low-risk children. Some variables showed an interaction effect, where impact was substantially higher in the high-risk group compared with the low-risk group. The utility of multiple risk constructs and process oriented approaches to protective factors are discussed.
Article
The developmental courses of high-risk and resilient children were analyzed in a follow-up study of members of a 1955 birth cohort on the island of Kauai, Hawaii. Relative impact of risk and protective factors changed at various life phases, with males displaying greater vulnerability than females in their first decade and less during their second; another shift appears under way at the beginning of their fourth decade. Certain protective factors seem to have a more general effect on adaptation than do specific risk factors.
Article
To examine the expression of war-related trauma as manifested by DSM-III-R rates of posttraumatic stress disorder (PTSD) and major depressive disorder in two generations of Cambodian refugees living in the western United States. A probability sample of 209 Khmer adolescents and one of their parents were interviewed using portions of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version and the PTSD section of the Diagnostic Interview for Children and Adolescents. Interviews were conducted in English by a master's-level clinician with a Khmer interpreter. PTSD was found to be significantly related across parent-child generations. A nonsignificant generational trend was also found for depressive disorders. A number of environmental variables measured in the study (amount of reported war trauma, loss, living arrangements, treatment received, socioeconomic status) were not related to these findings. Parents were more likely to report an earlier onset of PTSD symptoms. This study suggests that PTSD in refugees may cluster in families. Whether this phenomenon is caused by a genetic susceptibility to trauma awaits further research. PTSD and depressive disorders in refugee populations, while often comorbid, appear to follow different courses over time.
Article
This study empirically investigated the effects of post-traumatic stress disorder (PTSD) and combat level on Vietnam veterans' perceptions of their children's behavior, as well as its effects on their marital adjustment. Results indicated that the predictor variables of PTSD and combat level together explained 33.6% of the variance in perceived child behavior problems (p < .001) and 51.8% of the variance in marital adjustment (p < .001). In addition, PTSD and combat level, when observed together, reliably predicted internalizing and externalizing behavior problems in addition to four specific areas of marital adjustment. When observed individually, however, it was shown that child behavior problems and marital adjustment were predicted primarily by PTSD, rather than combat level.
Article
There is considerable evidence that psychiatric disorders aggregate in families, a phenomenon for which both genetic and nongenetic explanations have been proposed. However, since genetic and social inheritance usually co-occur, it is difficult to separate out their effects. In this paper, we argue that examining the rates of disorder among children of Holocaust survivors provides a special situation where genetic and nongenetic factors in familial transmission can be separated, and where specific nongenetic mechanisms can be tested. We specify competing hypotheses, and test their viability using data from an epidemiological study of psychiatric disorders conducted in Israel. We find no evidence of higher symptom scale scores or higher rates of current psychiatric disorders for the children of Holocaust survivors. However, they did have higher rates of past disorders.
Article
To determine the range and severity of post-traumatic stress disorder (PTSD) symptoms exhibited by children after exposure to a natural disaster. Three months after Hurricane Hugo struck Berkeley County, South Carolina, 5,687 school-aged children were surveyed about their experiences and reactions related to the storm. Self-reports of PTSD symptoms were obtained by use of a PTSD Reaction Index. Significant variation in the prevalence of PTSD symptoms was found across race, gender, and age groups. Self-reported symptoms were used to derive a post-traumatic stress syndrome classification according to DSM-III-R guidelines for the diagnosis of PTSD. More than 5% of the sample reported sufficient symptoms to be classified as exhibiting this post-traumatic stress syndrome. Females and younger children were more likely to receive this classification. At the symptom level, females reported more symptoms associated with emotional processing and emotional reaction to the trauma. Males were more likely to report symptoms related to cognitive and behavioral factors. Younger children were more likely to report symptoms overall. Children exposed to a high magnitude natural disaster report sufficient symptoms to establish a DSM-III-R derived classification of a PTSD syndrome. Differences between gender, age, and race groups appear to be related to differential risk of exposure, reporting biases, as well as a differential risk for developing post-traumatic symptoms.
Article
Longitudinal studies of children exposed to traumatic events show contrasting findings regarding their symptomatic change over time. The present study reports on a 30-month follow-up of preschool children and their mothers who had been exposed to Scud missile attacks. Families displaced during the Gulf War after their homes had been damaged by the missile attack and a control group whose homes remained intact were interviewed about posttraumatic and general symptomatology, the mothers' capacity to control images, and the children's adaptive behavior. Stress symptoms decreased in the displaced children but not in their mothers. Both reported more posttraumatic symptoms than did the control group. No differences in the children's adaptive behavior were observed. Posttraumatic symptoms of the displaced children correlated with the mothers' avoidant symptoms. The mothers' avoidant symptoms at follow-up were statistically explained by the mothers' symptoms during the war and their capacity for image control, the duration of displacement, and the cohesion of the family. The maternal stress-buffering capacity constitutes a central element in children's protective matrix and is crucial in minimizing long-term internal suffering of traumatized preschool children.
Article
Epidemiologic surveys in the general population documented a higher rate of posttraumatic stress disorder (PTSD) in women than in men. To date, the finding has received little scientific attention. This study examines the extent to which sex differences in PTSD might be explained by previously identified risk factors and whether the sex difference in PTSD varied by age at exposure to traumatic events. The NIMH-DIS (NIMH Diagnostic Interview Schedule, Version III Revised) was used to measure DSM-IIIR disorders in a random sample of 1007 young adults. Cox proportional hazards models were used to estimate changes in the hazards ratio for PTSD associated with sex when potential risk factors were included. Lifetime prevalence of exposure to traumatic events and number of traumatic events did not vary by sex. The prevalence of PTSD was higher for women than for men exposed to traumatic events (hazards ratio, 2.3; 95% confidence interval, 1.5-3.6). Preexisting anxiety disorders or major depressive disorders played a part in the observed sex difference in PTSD. Family history of anxiety disorder and early separation from parents, although significant risk factors for PTSD in subjects of both sexes, were unrelated to the sex difference in PTSD. The sex difference in PTSD was markedly greater if exposure occurred in childhood than later on. Posttraumatic stress disorder is more likely to develop in females than in males after exposure to a traumatic event. Susceptibility to PTSD in females might be greater in childhood than after age 15 years. Explanations of the sex difference might involve characteristics of individuals and of the traumatic experiences.
Article
To review current knowledge about the clinical presentation, assessment, and treatment of posttraumatic stress disorder (PTSD) in children. The literature on PTSD in children is examined. Over the past 10 years, PTSD has been described in children exposed to a variety of traumatic experiences. Little is known about the epidemiology of the disorder in children. Partial symptomatology and comorbidity are common. A variety of factors influence response to trauma and affect recovery. They include characteristics of the stressor and exposure to it; individual factors such as gender, age and developmental level, and psychiatric history; family characteristics; and cultural factors. Since the condition is likely to occur after disaster situations, much of the literature describes the child's response to disaster and interventions tend to include efforts within schools and/or communities. A number of clinical approaches have been used to treat the condition. While assessment has been studied extensively, the longitudinal course of PTSD and treatment effectiveness have not been. Biological correlates of the condition also warrant greater attention.
Article
This study explored sources of stress and psychosocial reactions of adolescents displaced as a result of the war in the Republic of Croatia. The most frequent stressful events they faced were loss of home (80%), loss of personal belongings (66.7%), separation from family members (66.7%), damage to property (48.9%), exposure to enemy attacks (46.7%), and death of a family member or friend (37.8%). Among the most frequent posttraumatic stress reactions were intrusive images (48.9%), loss of interest (40.9%), restlessness (37.8%), appetite disturbances (33.3%), and increased irritability (31.1%). The exposure to a greater number of stressful events was related to increased depression. More posttraumatic stress reactions were evident in females, in adolescents who were exiled for longer periods, and in those whose parents were more anxious. Adolescents who manifested a higher number of stress reactions had poorer expectations regarding their future.
Article
The purpose of this study was to compare the prevalence of Post Traumatic Stress Disorder and other diagnoses in three groups of abused children, sexual only (N = 127), physical only (N = 43), and BOTH (N = 34). The children, aged 7 to 13 years, were referred to the project from several sources at Arkansas Children's Hospital and from associated local agencies. The victims and caregivers were separately administered the Diagnostic Interview for Children and Adolescents, Revised Version (DICA). Additionally, caregivers and classroom teachers completed the Child Behavior Checklist (CBCL). Characteristics of the abuse were obtained from an investigative questionnaire. Both victims and caregivers endorsed high rates of disorders, with caregivers generally giving higher rates than children and boys having more externalizing diagnoses than girls. Children in the BOTH group had more diagnoses overall. Concordance between victims and caregivers was modest. PTSD was significantly comorbid with most affective disorders. On the CBCL, caregivers rated girls less disturbed than boys and the sexually abused only group less disturbed than the other groups. Teachers rated the boys more adversely than girls but did not see differences by abuse group. A younger age of onset of sexual abuse and coercion to maintain secrecy predicted a higher number of total diagnoses. Also, children who were physically abused by males had more diagnoses than those physically abused by females. Children who have been both physically/sexually abused appear to be at highest risk of psychiatric disturbance. PTSD, though common (circa one-third of victims), is generally comorbid with other affective disorders.
Article
There has been considerable controversy regarding the impact of the Holocaust on the second generation, but few empirical data are available that systematically document trauma exposure and psychiatric disorder in these individuals. To obtain such data, the authors examined the prevalence of stress and exposure to trauma, current and lifetime posttraumatic stress disorder (PTSD), and other psychiatric diagnoses in a group of adult offspring of Holocaust survivors (N=100) and a demographically similar comparison group (N=44). Subjects were recruited from both community and clinical populations and were evaluated with the use of structured clinical instruments. Stress and trauma history were evaluated with the Antonovsky Life Crises Scale and the Trauma History Questionnaire, PTSD was diagnosed with the Clinician Administered PTSD Scale, and other psychiatric disorders were evaluated according to the Structured Clinical Interview for DSM-IV. The data show that although adult offspring of Holocaust survivors did not experience more traumatic events, they had a greater prevalence of current and lifetime PTSD and other psychiatric diagnoses than the demographically similar comparison subjects. This was true in both community and clinical subjects. The findings demonstrate an increased vulnerability to PTSD and other psychiatric disorders among offspring of Holocaust survivors, thus identifying adult offspring as a possible high-risk group within which to explore the individual differences that constitute risk factors for PTSD.
Article
This study examined the relationship between participation in abusive violence in Vietnam and behavioral disturbances among children aged 6-16 in the next generation. As part of the National Vietnam Veterans Readjustment Study (NVVRS) detailed data were obtained on a national sample of male veterans who were living in households with children aged 6-16 (N = 257). Interviews with spouses/partners were used to evaluate current family relationships and child behavior. Children of veterans who participated in abusive violence showed more behavioral disturbance than children of other Vietnam veterans even after multivariate analysis was used to adjust for other factors such as PTSD symptoms, combat exposure, and postmilitary family relationships. Participation in abusive violence appears to affect parent-child relationships in a way that adversely influences children living at home.
Article
The aims of this study were to estimate the rate of post-traumatic stress reactions in Palestinian children who experienced war traumas, and to investigate the relationship between trauma-related factors and PTSD reactions. The sample consisted of 239 children of 6 to 11 years of age. Measures included the Rutter A2 (parent) and B2 (teacher) scales, the Gaza Traumatic Event Checklist, and the Child Post-Traumatic Stress Reaction Index. Of the sample, 174 children (72.8%) reported PTSD reactions of at least mild intensity, while 98 (41%) reported moderate/severe PTSD reactions. Caseness on the Rutter A2 scale was detected in 64 children (26.8%), which correlated well with detection of PTSD reactions, but not with teacher-detected caseness. The total number of experienced traumas was the best predictor of presence and severity of PTSD. Intervention programmes for post-war children need to be evaluated, taking into account developmental and cultural aspects, as well as characteristics of the communities involved.
Article
Studies in animals showed that stress results in damage to the hippocampus, a brain area involved in learning and memory, with associated memory deficits. The mechanism involves glucocorticoids and possibly serotonin acting through excitatory amino acids to mediate hippocampal atrophy. Patients with posttraumatic stress disorder (PTSD) from Vietnam combat and childhood abuse had deficits on neuropsychological measures that have been validated as probes of hippocampal function. In addition, magnetic resonance imaging (MRI) showed reduction in volume of the hippocampus in both combat veterans and victims of childhood abuse. In combat veterans, hippocampal volume reduction was correlated with deficits in verbal memory on neuropsychological testing. These studies introduce the possibility that experiences in the form of traumatic stressors can have long-term effects on the structure and function of the brain.
Article
This exploratory study compared 28 adolescent children of Vietnam combat veterans with 28 adolescents whose fathers were not in Vietnam on multiple variables related to (1) social and personal adjustment, (2) attitudes toward parents, and (3) personality development. The majority of outcomes were not significantly different. The children of combat veterans, however, showed poorer attitudes toward school; more negative attitudes toward their fathers; elevated scores of depression, tension, apprehension, and anxiety; lowered scores on creativity; and their mothers rated their behaviors as more problematic. Interactions with gender were not significantly different.