The War Experiences and Psychosocial Development of Children in Lebanon

This study examines the number and types of war traumas children face growing up in a war-torn country and the relation of such traumatic experiences to their psychosocial development. A sample of 224 Lebanese children (10–16 years old) were interviewed using measures of war exposure, mental health symptoms, adaptational outcomes, and Post-Traumatic Stress Disorder (PTSD). The number and type of children's war traumas varied meaningfully in number and type by their age, gender, father's occupational status, and mother's educational level. As predicted, the number of war traumas experienced by a child was positively related to PTSD symptoms; and various types of war traumas were differentially related to PTSD, mental health symptoms, and adaptational outcomes. For example, children who were exposed to multiple war traumas, were bereaved, became victims of violent acts, witnessed violent acts, and/or were exposed to shelling or combat exhibited more PTSD symptoms. Children who were separated from parents reported more depressive symptoms and children who experience bereavement and were not displaced reported more planful behavior. Lastly, children who were separated from parents and who witnessed violent acts reported more prosocial behavior. Implications for program interventions and directions for future research on the effects of war on the psychosocial development of children are explored.     

Psychological and physical intimate partner violence and young children’s mental health: The role of maternal posttraumatic stress symptoms and parenting behaviors

Young children are at significant risk of exposure to intimate partner violence (IPV), and vulnerable to exposure-related psychopathology, yet few studies investigate the effects of exposure to IPV on children under the age of 5 years. The current study investigated the role of maternal PTSD symptoms and parenting strategies in the relationship between mothers’ IPV experiences and psychopathology in their young children, ages 3–6 years in a community-based cohort of 308 mother-child dyads at high risk for family violence. Data were collected from 2011 to 2014. IPV history and maternal PTSD symptoms were assessed by self-report questionnaires. Children’s symptoms were assessed with a developmentally-sensitive psychiatric interview administered to mothers. Punitive/restrictive parenting was independently-coded from in-depth interviews with mothers about their disciplinary practices. Hypothesized direct and indirect pathways between physical and psychological IPV, maternal PTSD, maternal parenting style, and children’s internalizing and externalizing symptoms were examined with mediation models. Results indicated that neither physical nor psychological IPV experienced by mothers was directly associated with children’s symptoms. However, both types of victimization were associated with maternal PTSD symptoms. Examination of indirect pathways suggested that maternal PTSD symptoms mediated the relationship between mothers’ psychological and physical IPV experiences and children’s internalizing and externalizing symptoms and mothers’ restrictive/punitive parenting mediated the relationship between mothers’ psychological IPV and children’s externalizing symptoms. In addition, there was a path from maternal physical IPV to child externalizing symptoms through both maternal PTSD symptoms and restrictive/punitive parenting. Findings highlight the importance of supporting parents in recovering from the sequelae of their own traumatic experiences, as their ensuing mental health symptoms and parenting behaviors may have a significant impact on their children’s emotional health.     

Prevalence and determinants of post-traumatic stress disorder,anxiety and depression symptoms in street children survivors of the 2010 earthquake in Haiti,four years after

Working with street children and adolescents who lived through the 2010 earthquake in Port-au-Prince, this paper aims to assess the prevalence of symptoms of PTSD, anxiety and depression in relation to peritraumatic distress, and age, and to explore other risk factors and socio-demographic characteristics, four years after the events. Between March and June 2014, with a sample of 128 children and adolescents (120 boys and 8 girls) aged between 7 and 18, of an average age of 13.88 (SD = 2.15), all living on the streets of Port-au-Prince, we used the following scales: the Trauma Exposure (TE), the Life Events Subscale of the CAPS; the Peritraumatic Distress Inventory (PDI); the Children's Revised Impact of Event Scale (CRIES-13) and the Children Depression Inventory (CDI); (BAI). Our study reveals a high prevalence of PTSD, depression and anxiety among street children. It also demonstrates that this prevalence is lower than that of several other groups of children who were also victims of the 2010 earthquake in Port-au-Prince. Children living in the streets for economic reasons presented a lower prevalence of symptoms of PTSD, anxiety and depression than those who were on the streets as a result of psychological or physical abuse within their own families, in adoptive families or in children's homes. This study demonstrates the importance of care provision for these children in terms of helping them develop coping and resilience strategies. It also stresses the importance of providing them with nonviolent living environments and opportunities to facilitate their return to normality.     

Gender differences in social reactions to abuse disclosures, post-abuse coping, and PTSD of child sexual abuse survivors

OBJECTIVE:This research examines the understudied issue of gender differences in disclosure, social reactions, post-abuse coping, and PTSD of adult survivors of child sexual abuse (CSA). METHOD:Data were collected on a cross-sectional convenience sample of 733 college students completing a confidential survey about their demographic characteristics, sexual abuse experiences, disclosure characteristics, post-abuse coping, and social reactions from others. RESULTS:Female students reported greater prevalence and severity of CSA, more distress and self-blame immediately post-assault, and greater reliance on coping strategies of withdrawal and trying to forget than male students. Women were more likely to have disclosed their abuse to others, to have received positive reactions, and to report greater PTSD symptom severity, but were no more likely to receive negative reactions upon disclosure than men. Women delaying disclosure had greater PTSD symptom severity, whereas men's symptoms did not vary by timing of disclosure. Additional regression analyses examined predictors of PTSD symptom severity and negative and positive social reactions to abuse disclosures. CONCLUSIONS:Several gender differences were observed in this sample of college students in terms of sexual abuse experiences, psychological symptoms, coping, PTSD, and some aspects of disclosure and social reactions from others.     

Exploring school stress in middle childhood: interpretations,experiences, and coping

With increased academic and social challenges at school, middle childhood can be a particularly stressful time. The present study explored how a sample of children from a supportive learning environment interpreted, experienced and reported coping with everyday stress at school. Using a phenomenological approach, third graders attending an elementary school in the United States participated in semi-structured interviews in which they could discuss the nature of stress, stressful moments at school, and their responses to different situations. Despite nearly optimal learning conditions, child reports included a range of school stressors. Children’s interpretations of ‘stress’ seemed inextricably linked to their learning and social obstacles at school; those daily experiences were further linked to coping strategies. The discussion section emphasises the importance of understanding how children interpret and report stress and coping, and how pastoral care can support young students.     

Living with autistic spectrum disorder: parental experiences of raising a child with autistic spectrum disorder (ASD)

The focus of the study was to explore parental experiences of raising a child with autistic spectrum disorder (ASD). A mixed‐method approach consisting of questionnaires and semi‐structured interviews was used in order to elicit parental perspectives of raising a child with ASD. Two semi‐structured interviews were conducted with parents of children with ASD. Questionnaires were sent to parents of children with ASD in two special schools. The findings indicate that although each of the parents had a child with ASD, their experiences were all different. Many interesting accounts were documented and a wealth of information regarding the characteristic traits that children with ASD portray was recorded. The findings suggested that the majority of the parents experienced a low level of support from agencies and professionals. The general verdict was that of poor communication and a lack of understanding of parents' needs following formal diagnosis. Finally, a series of coping strategies were discovered ranging from family support to paid help.     

Protective factors associated with resilient functioning in young adulthood after childhood exposure to violence

Children may be subjected to many forms of violence and a significant number will experience multiple victimizations. These children are at high risk for developing psychological and emotional difficulties that may last into adulthood. Despite the increased risk for psychopathology, a substantial percentage of young adults exhibit resilient functioning following a history of childhood violence. This study examines the role of social support, spirituality, and emotional intelligence in promoting resilience during emerging adulthood. Participants included 321 young adult American college students, age 18–24, who experienced childhood violence, including community violence, interpersonal aggression, child maltreatment, peer/sibling victimization, and/or sexual assault. Findings revealed that this sample was highly victimized, with an average of 9 violent experiences reported during childhood. Hierarchical multiple regression analyses indicated that after controlling for exposure to childhood victimization, other potentially traumatic events, and current depression and anxiety symptoms, higher resilience during emerging adulthood was associated with greater spirituality, greater emotional intelligence, and support from friends (but not from family). Findings suggest that the potency of protective factors outweighs that of adversity and psychopathology when predicting resilient functioning. By identifying variables that can enhance resilience, this study offers unique insight into how functioning may be improved by both individual and environmental factors.     

儿童地震灾害创伤后应激障碍的心理干预策略初探

文章探讨了儿童灾难后心理应激状态下出现的创伤后应激障碍,分析了不同灾难下儿童经历创伤后应激障碍的发生率和儿童创伤后应激障碍的症状表现,并对经历地震的儿童创伤后应激障碍的干预提出一些有效的途径。     

The impact of patterns of trauma exposure among low income children with and without histories of child maltreatment

Previous research has revealed a large prevalence of trauma experienced by children, creating high risk for the development of psychopathology. Research investigating the negative impacts of child maltreatment and other traumas has typically examined these experiences individually, controlling for co-occurring traumas, or has combined these experiences into a general variable of risk, thereby obscuring the complex relationships among environmental traumas and maltreatment. The current study expands on previous research by elucidating relationships between multiple contexts of overlapping traumas and maltreatment experienced by children, and by categorizing how these experiences join together to impact internalizing and externalizing symptomatology. Participants included 316 maltreated children and 269 nonmaltreated children (M age = 9.4, SD = 0.88) who attended a summer day camp research program for low-income children. Latent Class Analysis (LCA) identified three differential patterns of trauma exposure across children: 1) community violence and loss; 2) pervasive trauma; and 3) low trauma. Covariate analyses demonstrated that child maltreatment was significantly associated with class membership, suggesting that maltreated children were more likely to experience diverse traumas extending beyond their maltreatment experiences (pervasive trauma class). A two-way analysis of variance also demonstrated that trauma latent class membership and child maltreatment each represented unique predictors of internalizing and externalizing symptoms, with each having an independent effect on symptomatology. This investigation provides unique insight into the differential impact of patterns of trauma exposure and child maltreatment, providing support for further research and clinical practice addressing multiple levels of a child’s ecology.     

Promoting resilience and wellbeing in children exposed to intimate partner violence: A qualitative study with mothers

BackgroundChildren exposed to intimate partner violence (IPV) are at increased risk of disruptions to their health and development. Few studies have explored mothers’ perceptions of what helps their children cope throughout this experience.ObjectiveThe aim of the study was to explore mothers’ perceptions of their children’s resilience and coping following IPV exposure, and the strategies they have used to support their children and promote resilience.MethodsIn depth semi-structured interviews were conducted with nine women from the Maternal Health Study (MHS), a prospective study of women during pregnancy and following the birth of their first child. All women involved in the qualitative interviews reported experiencing IPV during their involvement in the MHS. Transcribed interviews were analysed using interpretative phenomenological analysis which has a focus on how individuals make meaning of their experience.ResultsWomen discussed parenting strategies such as role modelling, stable and consistent parenting, and talking with their children about healthy relationships to promote their children’s resilience. Mothers also spoke about the ways they tried to reduce their child’s direct exposure to IPV, as well as reflecting on the difficulty of attending to their child emotionally when they were experiencing distress.ConclusionsThis study highlights that there are many strategies used by mothers who experience IPV to promote resilience and wellbeing in their children. Understanding what mothers see as useful for their children is essential in providing appropriate services to families following experiences of family violence.     

Post-traumatic stress and related symptoms among juvenile detention residents: Results from intake screening

BackgroundJuvenile justice-involved youth have high rates of trauma exposure, physical and sexual abuse and PTSD. Several factors have been found to be related to PTSD symptoms in youth including number and chronicity of traumatic events.ObjectiveTo simultaneously examine the relationships between allostatic load (defined here as number of traumatic experiences), poly-victimization (exposure to two or more forms of victimization based on 5 of the 6 categories in Ford et al.’s 2010 study), physical/sexual abuse and PTSD in justice-involved youth.Participants and SettingThe sample consisted of 1984 youth in juvenile detention in a Northeastern city. The sample was 73.4% male and the majority of youth were either African American or Hispanic.MethodsClinicians collected demographic and psychosocial information, and measured symptoms of PTSD, depression, and problematic substance use.ResultsResults showed that youth with more traumas, those who experienced poly-victimization and those who experienced physical/sexual assault/abuse were not only more likely to have PTSD, but also more likely to have depression, thoughts of suicide/self-harm, and problematic substance use (as indicated by the presence of 2 or more of 6 possible indicators). Poly-victimization was a stronger correlate of PTSD than number of traumas or physical/sexual assault/abuse. However, among youth with PTSD, number of traumas was associated with co-occurring problems while poly-victimization and physical/sexual assault/abuse were not.ConclusionsFindings can be used to help direct resources to juvenile justice-involved youth who are most in need of treatment.     

青少年复原力研究及其对灾后心理重建的启示

灾难事件虽然会给青少年带来一定的身心创伤,但也会不同程度地激发他们内在的复原力,发展出对抗灾难的勇气和智慧,并让他们获得自身的成长。汶川地震灾后,青少年的复原力能够直接降低PTSD,提升自尊,发展应对技巧和能力,促进社会交往并获得更多社会支持。激发灾后青少年复原力需要从个人、家庭、学校以及社会四个层面促进危险因子、压力事件与保护因子之间的平衡。因此,灾后青少年心理重建需要强调＂优势为本＂以及赋权的价值理念,坚持人与环境互动的运作框架,灵活运用多学科的工作方法,实施在地化和文化敏感性的心理重建策略。     

Trauma-related impairment in children—A survey in Sri Lankan provinces affected by armed conflict

ObjectivesThe present study examined traumatic experiences, PTSD, and co-morbid symptoms in relation to neuropsychological and school performance in school children affected by two decades of civil war and unrest.MethodThe epidemiological survey of children's mental health included a representative sample of 420 school children. Local teachers were trained to administer a translation of the UCLA-PTSD Index Form. The instrument and the epidemiological findings were validated by assessment through clinical expert interview, school grades, and neuropsychological testing in a subsample (N = 67).ResultsNinety-two percent of the children surveyed had experienced severely traumatizing events such as combat, bombing, shelling, or witnessing the death of a loved one. Twenty-five percent met the criteria for a diagnosis of PTSD. Traumatized children reported lasting interference of experiences with their daily life, which was corroborated by memory testing, scores in school performance and ratings of social withdrawal. Depressive symptoms and poor physical health were frequent in these children. The majority of trained teachers achieved valid results in the structured interviews.ConclusionPerformance and functioning in children are related to the total load of traumatic events experienced. An important component of psychosocial programs in post-conflict areas should include increasing community-based awareness of the consequences of traumatic stress, both as a preventative measure and as a way of decreasing stigmatization of affected individuals.     

Child refugees,trauma and education: interactionist considerations on social and emotional needs and development

This paper focuses on the social and emotional needs of children and young people who are refugees. It was inspired by casework undertaken by the author involving a 13‐year‐old boy who was a refugee from Montenegro. A vignette of the case is presented in addition to a review of relevant literature to illustrate and discuss the various sources of trauma experienced by children and young people who are refugees, and the potential impact of these on psychological functioning and emotional wellbeing. Child refugees’ experiences of trauma are seldom restricted to experiences of loss, violence or persecution in their country of origin. Rather, there are multiple experiences in the country of origin, during migration and on arrival in a country of “refuge” that are potentially traumatic, and can have adverse effects on a child or young person’s development. Drawing on research with children and adults who are refugees, as well as research into post‐traumatic stress disorder and into the educational effects of trauma, the paper advocates interactionist and ecosystemic perspectives for understanding the difficulties encountered by refugee children, and considers possibilities for therapeutic intervention.     

Alleged sexual abuse at a day care center: impact on parents

OBJECTIVE: This report describes the cascade of stressful events and secondary life changes experienced by parents in a case of alleged sexual abuse at a day care program. The study evaluated parents' Posttraumatic Stress Disorder (PTSD) symptoms and general psychological responses to the stressful events 4 years after the alleged abuse, and explored predictive factors of parental distress. METHODS: A total of 39 parents were interviewed about stressful events, life changes, and social support. Current distress reactions, psychological wellbeing, and locus of control were assessed with a battery of standardized measures. RESULTS: Hearing about the sexual abuse, testifying in court, hearing the verdict, and being exposed in media reports were all rated by the parents as distressing events. The majority of the parents experienced secondary life changes after the alleged sexual abuse. Four years after the alleged sexual abuse, one-third of the parents reported a high level of PTSD Intrusive symptoms and one-fourth reported a high level of PTSD Avoidance symptoms. There was a significant positive correlation between a measure of psychological wellbeing and PTSD. Secondary life changes and locus of control significantly predicted PTSD. CONCLUSION: This study demonstrates that the alleged sexual abuse of children in day care and the resulting events in the legal system and the media constitute significant and chronic stressors in the lives of the children's parents. These findings underscore the need to expand the focus of trauma-related sequelae from the child victim to their parents and family.     

灾后复原力及其干预的研究综述

灾后复原力（Resilience）领域近年受到心理学界的关注,尤其在5．12汶川地震后,对这一领域的关注更加突出。此前的研究表明,灾难性事件之后,个体所具有的复原力远比之前想像的要普遍,即使处于PTSD症状明显升高的高暴露情境下,具有较好复原力的个体仍不低于1／3。影响灾后复原力的因素包括个体的生理、心理因素和社会因素等。灾后进行心理干预可以帮助个体提高复原力,这些干预包括制订合理的早期干预计划、协助个体有效利用家庭资源和社会支持,以及有针对性的个别咨询等。     

Coping resources of maltreated children in the family: a salutogenic approach.

OBJECTIVE: Most research in child maltreatment within family focuses mainly on the pathological damage caused to the battered child. This study, based on a salutogenic approach, focuses on the resources that may help maltreated children to cope with their state and stay well. METHOD: Resilience was measured by two variables: perceived competence and psychological distress. The moderating or buffering variables that may contribute to better coping were: sense of family coherence, psychological sense of school membership, and social support. Two hundred and twenty-six 8th graders answered an anonymous self-report inventory. Based on the students' answers, they were divided into two groups: those who reported that they had been maltreated (MC) (n = 81) and those who did not (NMC) (n = 145). RESULTS: The study revealed a significantly high percentage of adolescents (35.6%) who reported having been maltreated within their families. A significant difference was found between the MC and the NMC in levels of perceived competence (higher for the NMC) and psychological distress (higher for the MC group). The moderating variables were found to have a differential effect on the dependent variables within the two groups. Sense of family coherence was found to be the main contributor to variance explanation of perceived competence among the MC, while sense of school membership had the main effect among NMC. CONCLUSIONS: The findings support a salutogenic approach in studying maltreated children. Implications on the possible detection of maltreated children in the community and on their coping resources that may contribute to resilience are discussed.     

Psychological maltreatment,coping strategies,and mental health problems: A brief and effective measure of psychological maltreatment in adolescents

Psychological maltreatment is an important social and public health problem and associated with a wide range of short and long-term outcomes in childhood to adulthood. Given the importance of investigating mitigating factors on its effect, the purpose of the present study is to investigate the mediating effect of active and avoidant coping strategies on the association between psychological maltreatment and mental health– internalizing and externalizing– problems in adolescents. Participants of the study consisted of 783 adolescents, ranging in age from 14 to 18 years (M = 15.57, SD = 0.88), with 52.9% female and 47.1% male. Several structural equation models were conducted to investigate the mediating role of coping strategies on the effect of psychological maltreatment on adolescents’ internalizing and externalizing problems. Findings from mediation analyses demonstrated the mediating effect of active and avoidant coping strategies on the association between psychological maltreatment and mental health problems. The outcomes support adolescents use more avoidant coping strategies and fewer active coping strategies in the face of psychological maltreatment experiences, and this affects their mental health. Taken together, these results should contribute to the design of prevention and intervention services in order to promote mental health.     

Posttraumatic stress disorder and emotion dysregulation among Syrian refugee children and adolescents resettled in Lebanon and Jordan

BackgroundSince the outbreak of the conflict in Syria, many people, including children and adolescents, have fled their homes into neighboring countries. Little research exists on the psychosocial adjustment of refugee children and adolescents resettled in Lebanon and Jordan.ObjectiveThis study investigated the prevalence and predictors of PTSD and emotion dysregulation in Syrian refugee children and adolescents who resettled in Lebanon and Jordan. It was hypothesized that a combination of pre-trauma variables (age and gender), trauma-specific variables (traumatic events and time spent in host country, and host country), and post-trauma variables (coping strategies, family relationships, and school environment) would be associated with PTSD and emotion dysregulation.Participants and SettingParticipants were 1000 Syrian refugee children and adolescents aged 7–18 years attending formal and non-formal schools representing various governorates in Lebanon and Jordan.MethodsThe trauma exposure scale, DSM-IV criteria for the assessment of PTSD, the Difficulties in Emotion Regulation Scale Short Form, Kidcope, Family relationship scales, and school environment scale were administered in an interview format with children and adolescents at school by two trained psychologists. Multivariate binary logistic regression was used to predict PTSD whereas hierarchical multiple regression was used to predict emotion dysregulation.ResultsResults indicated that 45.6% of the refugees have developed PTSD with excessive risk for comorbidity with emotion dysregulation. Emotion dysregulation was reported by older refugee children and adolescents. The prevalence of PTSD was higher in refugee children and adolescents who had resettled in Lebanon than for those who had resettled in Jordan. Refugee children and adolescents who were exposed to higher levels of war atrocities evidenced the greatest prevalence of PTSD and emotion dysregulation. PTSD symptomatology and emotion dysregulation in children and adolescents varied according to coping styles, family relationships, and school environment. Both decreased significantly with the passage of time spent in host country.ConclusionsThe results may be used to formulate cognitive–behavioral coping interventions that can lead to optimal developmental outcomes in the posttrauma environment.