Effects of bombardment on the manifest anxiety level of children living in kibbutzim

Child Rape: Extending the Therapeutic Intervention to Include the Mother-Child Dyad

In this his paper the authors describe therapeutic interventions with survivors of child rape and sexual abuse at Alexandra Clinic in Gauteng. Cases presenting at this community clinic are described, in the context of the startling increase in crimes against children and particularly sexual offences. The literature pertaining to the effects of trauma on children, important mediating factors in the child's experience and existing interventions with child trauma survivors are then reviewed. Attention is focused on studies taking into account the impact of the trauma on the child's familial environment. A description of the general intervention approach employed is followed by a deeper exploration of two core issues which characterised this approach — the identification of both mother and child as clients and the use of the mother-child relationship as a central focus for therapeutic intervention. It is suggested that these strategies enable greater access to the experience of the younger child in particular, address the effects of secondary traumatisation upon care-takers and ensure that the gains of therapy are extended to the child's larger social network.

Children's Affective Reactions and Coping under Threat of Uprooting

This study examines the response of children in the Golan Heights to the ambiguous situation during the continuing peace talks between Israel and Syria concerning a possible evacuation of the region's settlers. The study sample consisted of 218 fourth-grade children who responded to an adaptation of the Bar-Ilan Picture Test for Children (Itskovitz and Strauss, 1982, 1986). The results suggest that social support, defensiveness, religion and living in smaller settlements predicted better coping, whereas less social support and high emotional expressiveness predicted greater anxiety. The implications of these findings for school psychologists are discussed.

Risk factors for PTSD, anxiety, and depression among adolescents in Gaza

The present study examined among adolescents in Gaza the relationship between exposure to war stressors and psychological distress as well as the effects of age, gender, and socioeconomic status. Data were collected from a sample of 139 adolescents 12 to 17 years old. Results showed that adolescents reported elevated levels of intrusion, avoidance, and depression compared to levels in communities not affected by war in the recent past. The proportion scoring within the clinical range of posttraumatic stress disorder (PTSD) was 56.8% compared to 6.3% in peacetime populations, reflecting a Hedges's g of 1.29 (p < .001). Significant risk factors for PTSD were exposure (β = .377, p < .001), female gender (β = -.257, p < .001), older age (β = .280, p < .01), and an unemployed father (β = -.280, p < .01). Risk factors for anxiety were exposure (β = .304, p < .001), female gender (β = -.125, p < .01), and older age (β = 272, p < .01), whereas female gender (β = <.238, p < .001) was the only significant risk factor for depression. The present study suggests large individual differences in how adolescents are affected by war stressors.

Psychological reactions to Israeli occupation: Findings from the national study of school-based screening in Palestine

Children exposed to violent war-like and repeated political violence often experience a continued threat to life and their sense of safety, as well as a disruption of daily functioning. The purpose of the study was to examine the psychological impact of exposure to Israeli occupation on Palestinian school children in the West Bank and Gaza, Palestine. We assessed the association between exposure to occupation and the severity of posttraumatic symptoms and the inter-relationship between posttraumatic symptoms, functional impairment, somatic complaints, and coping strategies in school children. Palestinian students ( n = 2100) from grades 9—11 were screened from both the West Bank ( n = 1235) and Gaza ( n = 724) and responded to self-report questionnaires. Results showed that extensive exposure to violence was associated with higher levels of posttraumatic distress and more somatic complaints in both the West Bank and Gaza regions. More Gaza than West bank students reported symptoms meeting the criteria for PTSD, and more girls than boys in both groups reported somatic complaints. Thus, school-based screening can be an effective method for case identification of students showing PTSD symptoms as a result of exposure to political violence.

The well being of children living in chronic war zones: The Palestinian—Israeli case

The paper presents a comprehensive review and integration of available studies on the effects of severe traumatic experiences on children, especially in the context of short and enduring exposure to harsh events and adversities, as they relate to children who live in violent war zones, in particular in Israel and the Palestinian territories. The review focuses on the role of risk and protective factors in determining the debilitating and damaging effects as well as resiliencies of short term and chronic catastrophic experiences on the future well being of children and emerging adults.

Palestinian youth of the Intifada: PTSD and future orientation

OBJECTIVE

To assess the nature of chronic exposure to terror and its psychological and cognitive toll on Palestinian youths, as is reflected in posttraumatic symptoms, future orientation, and attitudes toward peace.

METHOD

In the summer of 2001, 245 Palestinian and 300 Israeli-Palestinian adolescents in the sixth to ninth grades were assessed with self-report questionnaires that measured level of exposure to terror, posttraumatic stress disorder, anxiety, depression, anger, dissociation, future orientation, and attitudes toward peace.

RESULTS

Palestinians experienced significantly more traumatic events than Israeli Palestinians; the groups did not differ, however, in their subjective perception of the threat. Palestinians also reported higher levels of posttraumatic symptoms, more pessimistic future orientation, and less favorable attitudes toward peace negotiations than the Israeli Palestinians. The groups did not differ in reported psychological symptoms related to chronic exposure to stress. In both groups, subjective perceptions of the threat were implicated in the pathogenic sequelae of exposure to terror-induced trauma.

CONCLUSIONS

Chronic or repeated exposure to terror may be related to complex posttraumatic symptoms beyond those specified in DSM-IV or ICD-10, including negative personal and national future orientation. The role of subjective appraisal deserves professional attention.

The psychosocial aspects of children exposed to war: practice and policy initiatives

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.

Children and war

Children bear disproportionate consequences of armed conflict. The 21st century continues to see patterns of children enmeshed in international violence between opposing combatant forces, as victims of terrorist warfare, and, perhaps most tragically of all, as victims of civil wars. Innocent children so often are the victims of high-energy wounding from military ordinance. They sustain high-energy tissue damage and massive burns - injuries that are not commonly seen in civilian populations. Children have also been deliberately targeted victims in genocidal civil wars in Africa in the past decade, and hundreds of thousands have been killed and maimed in the context of close-quarter, hand-to-hand assaults of great ferocity. Paediatricians serve as uniformed military surgeons and as civilian doctors in both international and civil wars, and have a significant strategic role to play as advocates for the rights and welfare of children in the context of the evolving 'Laws of War'. One chronic legacy of contemporary warfare is blast injury to children from landmines. Such blasts leave children without feet or lower limbs, with genital injuries, blindness and deafness. This pattern of injury has become one of the post-civil war syndromes encountered by all intensivists and surgeons serving in four of the world's continents. The continued advocacy for the international ban on the manufacture, commerce and military use of antipersonnel landmines is a part of all paediatricians' obligation to promote the ethos of the Laws of War. Post-traumatic stress disorder remains an undertreated legacy of children who have been trapped in the shot and shell of battle as well as those displaced as refugees. An urgent, unfocused and unmet challenge has been the increase in, and plight of, child soldiers themselves. A new class of combatant comprises these children, who also become enmeshed in the triad of anarchic civil war, light-weight weaponry and drug or alcohol addiction. The International Criminal Court has outlawed as a War Crime, the conscription of children under 15 years of age. Nevertheless, there remain more than 300000 child soldiers active and enmeshed in psychopathic violence as part of both civil and international warfare. The typical profile of a child soldier is of a boy between the ages of 8 and 18 years, bonded into a group of armed peers, almost always an orphan, drug or alcohol addicted, amoral, merciless, illiterate and dangerous. Paediatricians have much to do to protect such war-enmeshed children, irrespective of the accident of their place of birth. Only by such vigorous and maintained advocacy can the world's children be better protected from the scourge of future wars.

Adolescent understandings of political violence and psychological well-being: a qualitative study from Bosnia Herzegovina

The Harvard Trauma Questionnaire and Hopkins Symptoms Checklist (HSCL-25) were given to 337 13-15 year olds who had lived through the recent war in Bosnia Herzegovina, on opposite sides of the conflict. A gender-balanced sub-sample of 40 adolescents was selected on the basis of their combined symptom scores, including equal numbers of high and low scorers from each side. A year of participant observation in two cities and in-depth interviews were conducted with the sub-sample to explore their understandings of the war and their subjective perceptions of their psychological well-being. Case studies are presented to show that the degree to which an adolescent engaged in a search for meaning to the conflict is related to their psychological well-being. Searching for meaning did not appear to be protective. Less well adolescents in both cities were more engaged in searching for meaning. Well adolescents appeared to be more disengaged. Searching for meaning appeared to be associated with sensitivity to the political environment, and feelings of insecurity about the prospect of a future war. The particular local context had an important effect in mediating the manner in which disengagement and engagement occurred. These findings suggest that the more avoidant methods of coping with political violence warrant further investigation. Political engagement may be protective in low-level conflicts where there is a possibility for action. When there is little opportunity for active engagement, the search for meaning has a different effect. Adolescents engaged in the search for meaning recognise that their recovery is bound up with the recovery of their communities as a whole. Assistance and support may have to address the material, social and political difficulties that the search uncovers.

War exposure among children from Bosnia-Hercegovina: psychological adjustment in a community sample

As part of a United Nations Children's Fund (UNICEF) psychosocial programme during the war in Bosnia-Hercegovina, data were collected from a community sample of 2,976 children aged between 9 and 14 years. Children completed standardized self-report measures of posttraumatic stress symptoms, depression, anxiety, and grief, as well as a report of the amount of their own exposure to war-related violence. Results showed that children reported high levels of posttraumatic stress symptoms and grief reactions. However, their self-reported levels of depression and anxiety were not raised. Levels of distress were related to children's amount and type of exposure. Girls reported more distress than boys, but there were few meaningful age effects within the age band studied. Results are discussed in the context of service development for children in war.

Psychological responses to blood vengeance among Arab adolescents

OBJECTIVE

The goal of this study was to investigate the well being of Arab adolescents who live under the threat of ongoing blood vengeance, and to assess the impact of socio-demographic characteristics, cultural context, and family functioning as a mediators factors.

METHOD

The sample consisted of 100 adolescents in grades 6-8. Self-reported standardized measures were used to assess the participants' level of self-esteem (Rosenberg's scale), mental health (the Brief Symptom Inventory BSI), and perceived family functioning (the McMaster Family Assessment Device FAD).

RESULTS

The participants of this study demonstrated higher levels of distress and symptomatic behavior as compared to the Israeli norms. In a series of multiple regression, General Family Functioning emerged as the major predictor associated with mental health. Female participants reported a higher anxiety level than their male counterparts. Male participants, on the other hand, were more willing to continue the feud of blood vengeance.

CONCLUSION

The findings suggest that there are similarities among children and adolescents who live in war zones and those who live under a threatening blood vengeance. Family functioning appears as the major mediator of well being. Implications for practice are discussed.

Do children cope better than adults with potentially traumatic stress? A 40-year follow-up of Holocaust survivors

Anecdotal reports suggest that child survivors of the Nazi persecution are functioning well as adults. Ratings of their parents by a randomly selected community sample of young adult Ashkenazi Jews on a scale that measured Schizoid, Paranoid, Depressive/Masochistic and Type A/Normal Aggressive symptoms permitted verification of these reports. Among the parents were groups who were children, adolescents, or young adults in 1945, at the end of World War II. Child-survivor parents did not differ from native-born parents on these measures 40 years later, whereas, consistent with the empirical findings of others, survivors who were adolescents or young adults at the end of the war manifested more paranoid and depressive/masochistic symptoms than native-born parents. To explain this possible greater long-term resilience among those who were child survivors, reference is made to later caretakers, endowment, cognitive and social development, and psychodynamics.

Individual differences in posttraumatic distress: problems with the DSM-IV model

OBJECTIVE

To evaluate the evidence concerning the role of threatening life events in accounting for clinically significant posttraumatic stress responses.

METHOD

Research was examined to review the epidemiology, evidence of dose-response relations, and individual difference factors in accounting for variations in conditions, including posttraumatic stress disorder, after exposure to threatening events.

RESULTS

The evidence is significantly discrepant from the clinical Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) model. Greater distress arises from individual differences than from event characteristics. Important individual differences that interact with threat exposures include trait negative affectivity (neuroticism); beliefs about emotions, the self, the world, and the sources and consequences of danger; and prevent acts, disorders, and intelligence. Reasons for the discrepancies between the evidence and the current model of posttraumatic distress are proposed.

CONCLUSION

In accounting for responses to threatening life events, the relatively minor contribution of event qualities compared with individual differences has significant treatment implications. Treatment approaches assuming that toxic event exposure creates a posttraumatic disorder fail to consider individual differences that could improve treatment efficacy.

A cross-cultural comparison of behavior disturbance and suicidal behavior among psychiatrically hospitalized adolescents in Israel and the United States

American adolescent psychiatric patients had significantly higher levels of suicidal behavior (49% vs. 19%) and a higher percentage of depression diagnoses (78% vs. 24%) than Israeli psychiatric inpatients. After controlling for the diagnosis of depression, American male patients obtained significantly higher scores on the Obsessive-Compulsive, Aggression, and Hyperactive subscales of the Child Behavior Checklist (CBCL) than the Israeli males. American females scored higher on the Depression subscale than Israeli females. Differences may be attributed to less tolerance or differing perceptions of deviant behavior in America, clinical practice, and/or the CBCL's greater applicability to American inpatient samples.

The impact of political violence on moral reasoning in children

OBJECTIVE

The moral development of three groups of children, who had been subjected to varying degrees of political violence and economic advantage, was examined in an attempt to determine if group membership or gender influenced the level of moral reasoning or orientation.

METHOD

Ninety-three 8- to 13-year-old Israeli Jewish and Bedouin school children, and Palestinian West Bank school children were asked various moral reasoning questions based on an animal fable involving a moral dilemma under three (hypothetical, role-taking, political) conditions.

RESULTS

Results indicate that mutuality solutions to moral dilemmas were given more frequently by Israeli Jewish children than Israeli Bedouin or Palestinian children as the questions shifted from abstract to real-life situations. No significant gender differences were found between Jewish children and Bedouin children in hypothetical issues; however, violence and limited resources were found to affect moral judgment in real-life situations for boys, but not for girls.

CONCLUSIONS

These findings supported the hypothesis that moral reasoning in children is significantly linked to real-life situations and resources. The results were discussed in terms of their relevance to future researchers and the manner in which children interpret moral questions.

War experiences and distress symptoms of Bosnian children

OBJECTIVE

The war in Bosnia has had a tremendous impact on civilians. Little is known about the impact of modern warfare on children. This survey documents the nature and frequency of war-related experiences among Bosnian children and describes their manifestations of selected psychological sequelae.

METHODS

A cross-sectional survey of 364 internally displaced 6- to 12-year-old children and their parents living in central Bosnian collectives was conducted during the war. Parents were surveyed for their children's war experiences; the children were surveyed for war-related distress symptoms.

RESULTS

The children were exposed to virtually all of the surveyed war-related experiences. The majority had faced separations from family, bereavement, close contact with war and combat, and extreme deprivation. The prevalence and severity of experiences were not significantly related to a child's gender, wealth, or age, but were related to their region of residence, with children from the region of Sarajevo having the highest prevalence of experiences. Almost 94% of the children met Diagnostic and Statistical Manual of Mental Disorders, 4th ed, criteria for posttraumatic stress disorder. Significant life activity affecting sadness and anxiety were reported by 90.6% and 95.5% of the children, respectively. High levels of other symptoms surveyed were also found. Children with greater symptoms had witnessed the death, injury, or torture of a member of their nuclear family, were older, and came from a large city.

CONCLUSIONS

The war-related experiences of the children studied were both varied and severe, and were associated with a variety of psychological sequelae. This experience underscores the vulnerability of civilians in areas of conflict and the need to address the effects of war on the mental health of children.

Resilience among youth growing up in substance-abusing families

This article presents the Challenge Model, a new clinical paradigm for evaluating the children of alcoholics and other substance-abusing parents. Unlike traditional risk paradigms, the Challenge Model incorporates both the resilience and the vulnerabilities that can result from struggling with hardship early in life. A developmental vocabulary of strengths is provided for pediatricians to use in research, clinical thinking, and treatment and prevention efforts with COAs.

Children exposed to disaster: II. Risk factors for the development of post-traumatic symptomatology

OBJECTIVE

To examine the influence of subject and exposure variables on the development of post-traumatic stress disorder (PTSD) symptoms and syndrome in children exposed to disaster.

METHOD

Three months after Hurricane Hugo, 5,687 school-aged children were surveyed about their experiences and reactions to the hurricane. Self-reports of PTSD symptoms were obtained by use of a PTSD Reaction Index.

RESULTS

The presence of PTSD symptoms was strongly related to children's reported severity of the hurricane, degree of home damage sustained, and continued displacement; however, children's level of trait anxiety and their reported emotional reactivity during the hurricane were more strongly related to the presence of PTSD symptoms than were the exposure factors. Different sets of risk factors appeared to differentially influence the development of the three DSM-III-R PTSD symptom clusters. Little evidence for a differential effect of the risk factors between females and males and younger and older children was found.

CONCLUSIONS

Level of trait anxiety appears to be the single strongest risk for the development of severe post-traumatic reactions. The higher rate of post-traumatic symptoms in females and younger children in combination with the absence of differential reaction to the risk factors suggests that females and younger children are more likely to develop posttraumatic reactions following a disaster.

Ecological integrated model of children of war: individual and social psychology

The psychological trauma associated with war is a topic that has occupied the attention of mental health researchers and practitioners for some time. Most of their attention, though, has focused on the traumatic stress of soldiers, and little attention has been paid to the problems and traumatization of civilians caught in war zones, especially the children. In this paper, the limited research on children of war is reviewed, and themes are extracted. Children suffer from both acute and chronic traumatic stress. The key to determining the amount of suffering has to do with the dynamic interaction among five processes within an ecological framework: the child's psychobiological makeup, the disruption of the family unit, the breakdown of community, and the ameliorating effects of culture. The intensity, suddenness and duration of the war-like experience itself constitute an additional component to this ecological model. In the final section, psychotherapeutic guidelines to help children cope with symptoms associated with war are presented for current and future caregivers. The prevention of war should be the primary task of all.

Screening and psychological debriefing of adolescent survivors of life-threatening events

There is a perceived need for schools and casualty departments to receive appropriate information and guidelines in order to minimise the effect of PTSD. A recommended screening battery for PTSD was administered at the start of a two-session debriefing group and again three months later to a group of seven young survivors of a minibus accident. No studies using this screen other than those of shipping disasters have been reported to date. Screen scores were compared with those of survivors of the cruise ship Jupiter. No significant differences were found between minibus survivors when assessed at six months (before intervention), and Jupiter survivors, who when assessed at five months had already undergone debriefing. Post-debriefing assessment of minibus survivors demonstrated significant reductions on all measures.

Children as victims of war: current knowledge and future research needs

Recent international events have drawn attention to the effects of war-related events and processes on children and their families. This review of the literature concerning the existence, frequency, and type of social, emotional, and behavioral problems in children exposed to war indicates significant methodological problems in previous research. Available evidence suggests that massive exposure to wartime trauma seems likely to overwhelm most children's defenses; however, children's cognitive immaturity, plasticity, and innate adaptive capacities may mitigate war's effects in low-to-moderately intense wartime settings, resulting in self-protective, adaptive, cognitive styles that allow effective functioning after acclimatization. Promising recent research has shifted from the focus on psychopathology to social awareness, values, and attitudes. More research will be needed to determine how age, developmental, family, and community factors may mediate the strength and nature of wartime effects, and to determine which interventions are most effective in a variety of settings and cultural contexts.

The NIMH community violence project: II. Children's distress symptoms associated with violence exposure

The rising tide of violence in American cities has placed the causes and consequences of violence squarely on the public health agenda. The U.S. Government's Year 2000 National Health Promotion and Disease Prevention Objectives includes a full chapter devoted to violence issues and delineates a number of goals and programs aimed at reducing the number of deaths and injuries associated with violence (Public Health Service 1990). Notably absent from these objectives, however, is attention to the possible adverse psychological consequences of exposure to acute or chronic violence. Nonetheless, in light of numerous media reports of children's exposure to community violence and recent reports documenting high levels of exposure even among very young children (Richters and Martinez 1993), it is reasonable to question whether the risks of exposure extend beyond death and physical injury to psychological well-being.

Experiences of Violence in the Lives of Township Youths in ‘Unrest’ and ‘Normal’ Conditions

Political violence has attracted the attention of psychological researchers in South Africa. In comparison, the more habitual forms of violence occurring in townships have been neglected. In this study the authors investigate the experiences of violence of two cohorts of township youths; one which had recently experienced the violence of ‘unrest’ and one which had not. A comparison of the two cohorts revealed some differences, which are related to ‘unrest’. There are, however, many similarities which indicate consistencies in experiences of violence regardless of ‘unrest’. It is concluded that the more habitual forms of violence deserve more research attention.

Children's reactions to war-related stress. Affective symptoms and behaviour problems

Questionnaire responses from mothers of 1,039 Lebanese 3-9 yr olds were used to study the effects of children's experiences in war on their emotional and social behaviour. Children who had experienced death of a family member, forced displacement of family, or destruction of home or had witnessed death (30% of sample) were about 1.7 times more likely than those who had not to exhibit nervous, regressive, aggressive and depressive behaviour reactions to a general war stress situation (shelling). Findings are discussed with respect to: (a) research relating stressful life events to onset of psychological disorder and (b) societal implications of youngsters' being repeatedly exposed to models of aggression and the violent resolution of interpersonal disputes.

Children in political violence

There is an urgent need to conduct research into the effects of political conflict on children growing up in South Africa. This paper discusses some international literature which may be relevant to researchers in this area. The first section briefly assesses the usefulness of the background literature on children in war and disaster situations. The second section outlines some of the clinical effects of political conflict on children. The third illustrates some of the ways in which intra-personal, inter-personal and contextual factors play a role in the stress process. The fourth section incorporates previous discussion into a model for understanding the effects of political conflict on children and offers a brief critique of some of the existing research. The final section explores the implications of the international literature for the South African researcher and examines the usefulness of conducting this kind of research.

Recent life events and psychiatric disorder in children: the interaction with preceding extreme adversity

This prospective study investigated the role that life events play in causing emotional and behavioural problems in a population of 240 primary school children who had recently survived a natural disaster. Life events experienced after the disaster were not found to contribute directly to the number of emotional or behavioural problems when the effect of the disaster was taken into account. This suggested that, in children, life events may not have a simple mechanically additive aetiological effect.

Behavior therapy for separation anxiety disorder

The empirical research on the condition labeled separation anxiety disorder (SAD) is reviewed, including studies on its diagnostic criteria, etiology, natural history, and response to behavior therapy. Although the available treatment reports are promising, little experimental evidence exists that specifically demonstrates the efficacy of behavior therapy or any other approach to care for the child with separation anxiety disorder. It appears that SAD is a variant of other anxiety disorders and has a similar positive response to treatments incorporating elements of therapeutic exposure to anxiety-evoking stimuli.

A longitudinal study of the psychological morbidity in children due to a natural disaster

This longitudinal study examined the psychological impact of a bushfire disaster on a group of 808 children aged from 5 to 12. Contrary to prediction, the prevalence of behaviour and emotional problems 2 months after the fire was less than the prevalence in a carefully selected comparison group. Rather than decrease with time, the prevalence of psychological morbidity increased significantly, being as great 26 months after the disaster as at 8 months.

Family functioning and overprotection following a natural disaster: the longitudinal effects of post-traumatic morbidity

The longitudinal impact of a natural disaster on the patterns of interaction in families with latency-aged children is examined. An 11-item questionnaire was developed and two factors were isolated: irritable distress and involvement. A group of 183 disaster-affected families were contrasted with 497 families who had not been exposed to the disaster. Eight months after the disaster, the interaction in the disaster-affected families was characterised by increased levels of conflict, irritability and withdrawal. Maternal overprotection was also a common feature of the pattern of care in these families. Post-traumatic morbidity in parents was the major determinant of the observed changes in family functioning and the overprotection.