CHILDREN EXPOSED TO WAR

Few Studies on Psychological Impact of War on Children

Reactions to War Mediated by Maturation

    Physical
    Cognitive
    Emotional
    Social

Children Have Not Resolved Issues of

    Separation/Individuation
    Emerging Self-concept
    Consolidating Coping Repertoire

Exposure to War Can Adversely Impact

    Process of Identity / Personality Formation
    Acquisition of Impulse Control (aggression)
    Internalization of Moral / Ethical Standards
    Modes of Relating to Others

War-related Trauma Is Diverse (witness vs. media)

    No Evidence for Specificity in Adjustment

LITTLE OR NO REACTION

    Less Intense than Predicted

        Shelled Kibbutzim vs. Non-communal Settlements
        
        Resilience and/or Habituation

            Support
            Shared Ideology / Religion
            Sense of Community

    Marked Increase in Intensity of Existing War

        Heightened Psychological Morbidity

ACUTE EFFECTS

    Proximity to Impact Zone
    Frequency and Intensity of Exposure

        Palestinian Children 6-11 Years Old
            
            73% with Mild PTSD
            41% with Severe PTSD

        Kuwaiti Children 8-12 Years Old

            62% with Mild PTSD
            27% with Severe PTSD

LONG-TERM EFFECTS
    
    Primary x Secondary Stressors
        
        War-related Trauma

        Compromised Social Infrastructure

            Poverty
            Separation from Loved Ones
            Malnutrition
            Overcrowding
            Lawlessness

        Lebanese Children
            
            43% Have PTSD Symptoms 10 Years Later

        Croatian Children

            Feel Unsafe in Streets
            Diagnosed with School Problems
            Frequently Ill

    Biological Impact

        Intensity, Frequency, Duration of Trauma ==> Stress / Neurotransmitter Systems ==>
        
            Anxiety and Mood Disorders
            Aggressive Dysregulation Problems
            Autoimmune Dysfunction
            Structural CNS Changes
            Early Death

GENDER DIFFERENCES

    Girls Susceptible to Internalizing Symptoms

        Anxiety upon Exposure to Trauma
        Anxiety and Depression Later

    Boys Manifest more Externalizing Symptoms

         Acting-out Disorders

OTHER MODERATORS

    Pre-trauma Adjustment
    
    Age

        Older Children more Vulnerable
        
            Independently Evaluate Danger

    Peri-traumatic Reactions

        Subjective Appraisal / Prediction
    
            Fear of Dying and/or Losing Family
    
        Stronger Predictor than Direct Exposure

TRAUMATIC BEREAVEMENT

    Loss of Parents and/or Siblings in Peacetime

        Varying Psychological Morbidity

    Loss of Parents and/or Siblings in Natural Disasters

        Bereavement x Threat to Life
        Prolonged Maladjustment (e.g., depression)

    Death of Father in War
        
        3.5 Years after, 2-10 Year Olds

            50% - Over-dependency, Tantrums, Fears
            40% - Clinical Bereavement

        Moderators
            
            Quality of Prior Relationship with Father
            Ability of Mother to Share Grief with Child
            Availability of Extended Family

    Parental Absence

        Absence in Peacetime
            
            Mild Psychological Consequences

        Absence due to Deployment
            
            1991 Gulf War
                
            More Severe Depression and Stress
            Levels within Normal

PROTECTIVE FACTORS

    Capacity to Recognize and Avoid Danger
    Capacity to Manage Anxiety
    Ability to Use Adults for Caretaking
    Family Cohesion and Social Support
    Shared Values and Beliefs with Other Children
    Ability to Devote Oneself to Meaningful Activity
        
DISCUSSION:

➢    Given the protective factors above and other moderators listed earlier, how would you design a comprehensive program to prevent and remediate the adverse impact of war on children?