The impact of prenatal maternal stress due to potentially traumatic events on child temperament: A systematic review

The objective of the current study was to complete a systematic review of the relationship between prenatal maternal stress due to potentially traumatic events (PTEs) and child temperament. Eligible studies through June 2020 were identified utilizing a search strategy in PubMed and PsycInfo. Included studies examined associations between prenatal maternal stress due to PTE and child temperament. Two independent coders extracted study characteristics and three coders assessed study quality. Of the 1969 identified studies, 20 met full inclusion criteria. Studies were classified on two dimensions: (1) disaster-related stress and (2) intimate partner violence during pregnancy. For disaster-related prenatal maternal stress, 75% (nine out of 12) of published reports found associations with increased child negative affectivity, 50% (five out of 10) also noted associations with lower effortful control/regulation, and 38% (three out of eight) found associations with lower positive affectivity. When considering prenatal intimate partner violence stress, 80% (four out of five) of published reports found associations with higher child negative affectivity, 67% (four out of six) found associations with lower effortful control/regulation, and 33% (one out of three) found associations with lower positive affectivity. Prenatal maternal stress due to PTEs may impact the offspring's temperament, especially negative affectivity. Mitigating the effects of maternal stress in pregnancy is needed in order to prevent adverse outcomes on the infant's socioemotional development.

Family depression profiles among adolescents and their parents: A group-based multitrajectory modeling

Early onset of depression predicts unfavorable psychosocial and health outcomes, and depression often co-occurs for children and their parents, yet family profiles of depression trajectories are not fully examined. This population-based longitudinal prospective cohort study included 2,111 families drawn from the Chinese Family Panel Study (CFPS) with biannual assessments from 2010 to 2018. Group-based multitrajectory modeling was used to identify depression trajectories of children, fathers, and mothers. Six distinct profiles of depression symptoms were identified. Based upon multitrajectory findings of family depression profiles, when adolescents are at risk for depression, there is likely at least one parent concurrently at risk for depression, but not vice versa. Families with social disadvantages and children of delayed developmental milestones are at elevated risk for depression. Even when children are at low risk for depression, depression in parents can spill over to impact other psychosocial and health outcomes. These findings suggest examining depression and its associating psychosocial factors could help identify trajectories of varying onset and continuity, which can inform early prevention and intervention from a family system perspective. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Clinical, financial and social impacts of COVID-19 and their associations with mental health for mothers and children experiencing adversity in Australia

BACKGROUND

Australia has maintained low rates of SARS-COV-2 (COVID-19) infection, due to geographic location and strict public health restrictions. However, the financial and social impacts of these restrictions can negatively affect parents' and children's mental health. In an existing cohort of mothers recruited for their experience of adversity, this study examined: 1) families' experiences of the COVID-19 pandemic and public health restrictions in terms of clinical exposure, financial hardship family stress, and family resilience (termed 'COVID-19 impacts'); and 2) associations between COVID-19 impacts and maternal and child mental health.

METHODS

Participants were mothers recruited during pregnancy (2013-14) across two Australian states (Victoria and Tasmania) for the 'right@home' trial. A COVID-19 survey was conducted from May-December 2020, when children were 5.9-7.2 years old. Mothers reported COVID-19 impacts, their own mental health (Depression, Anxiety, Stress Scales short-form) and their child's mental health (CoRonavIruS Health and Impact Survey subscale). Associations between COVID-19 impacts and mental health were examined using regression models controlling for pre-COVID-19 characteristics.

RESULTS

319/406 (79%) mothers completed the COVID-19 survey. Only one reported having had COVID-19. Rates of self-quarantine (20%), job or income loss (27%) and family stress (e.g., difficulty managing children's at-home learning (40%)) were high. Many mothers also reported family resilience (e.g., family found good ways of coping (49%)). COVID-19 impacts associated with poorer mental health (standardised coefficients) included self-quarantine (mother: β = 0.46, child: β = 0.46), financial hardship (mother: β = 0.27, child: β = 0.37) and family stress (mother: β = 0.49, child: β = 0.74). Family resilience was associated with better mental health (mother: β = -0.40, child: β = -0.46).

CONCLUSIONS

The financial and social impacts of Australia's public health restrictions have substantially affected families experiencing adversity, and their mental health. These impacts are likely to exacerbate inequities arising from adversity. To recover from COVID-19, policy investment should include income support and universal access to family health services.

Debate: The toll of the COVID-19 pandemic on children's risk for suicidal thoughts and behaviors

The consequences of the COVID-19 pandemic on risk for suicidal thoughts and behaviors (STBs) in children are still not fully known. However, COVID-19 and the mitigation strategies to limit its transmission have affected children and adolescents through increased parental morbidity and mortality, increased poverty and financial strain, social isolation, and lost connectedness to school, peers, and afterschool activities. These are all associated with increased risk for psychiatric disorders and STBs in children. Mental health professionals and pediatric primary care settings need to monitor psychiatric symptoms and risk for STBs in children and especially among those who were directly affected during the pandemic in order to reduce the burden of the pandemic on children and families.

COVID-19 related posttraumatic stress disorder in children and adolescents in Saudi Arabia

INTRODUCTION

The COVID-19 pandemic resulted in quarantine/lockdown measures in most countries. Quarantine may create intense psychological problems including post-traumatic stress disorder (PTSD) especially for the vulnerable critically developing children/adolescents. Few studies evaluated PTSD associated with infectious disasters but no Saudi study investigated PTSD associated with COVID-19 in children/adolescents. This study was undertaken to screen for PTSD in children/adolescent in Saudi Arabia to identify its prevalence/risk factors during COVID-19 pandemic and its quarantine.

METHODS

A cross-sectional survey was conducted after 2 months form start of quarantine for COVID-19 pandemic utilizing the original English version and an Arabic translated version for the University of California at Los Angeles Brief COVID-19 Screen for Child/Adolescent PTSD that can be parent-reported or self-completed by older children/adolescents. Participants (Saudi citizens/non-Saudi residents) were approached online via social media.

RESULTS

Five hundred and thirty seven participants were enrolled. The participants were 262 boys and 275 girls with a mean age of 12.25±3.77 years. Symptoms of no, minimal, mild and potential PTSD were identified in 15.5%, 44.1%, 27.4% and 13.0% of children/adolescents, respectively. The age, gender, school grade, and residence were not predictive of PTSD symptoms. Univariate analysis of risk factors for PTSD revealed that work of a close relative around people who might be infected was significantly different between groups of PTSD symptoms, but this difference disappeared during multivariate analysis. Children/adolescents of Saudi citizens had significantly lower median total PTSD score than children/adolescents of expatriate families (p = 0.002).

CONCLUSION

PTSD associated with the COVID-19 and its resultant quarantine shouldn't be overlooked in different populations as it is expected in a considerable proportion of children/adolescents with variable prevalence, risk factors and severity. Parents/healthcare providers must be aware of PTSD associated with COVID-19 or similar disasters, so, they can provide children/adolescent with effective coping mechanisms.

He knew more than we wanted him to know: Parent perceptions about their children's sense of pediatric cancer-related financial problems

BACKGROUND

Treatment for pediatric cancer generates costs that place sizeable demands on family finances relative to household income. Little is known about whether children sense that their cancer has created financial problems for the family. The study purpose was to describe parents' perceptions about whether their child sensed that pediatric cancer created financial problems for their family.

PROCEDURE

Family Communications Theory informed our study. We used descriptive statistics and content analysis to examine parents' (n = 417) responses to questions about the child's sense of pediatric cancer-related financial problems from a larger survey study.

RESULTS

Approximately 56.2% of parents indicated that their child had no sense of the pediatric cancer-related financial problems and 44.1% indicated their child had some. Proportions of children perceived to sense these financial problems steadily increased with age grouping, while proportions perceived to have none declined. With content analysis, we identified cognitive capacity as the key child factor influencing children's sense of these problems. Influential context factors included social norms, observed changes in family routines and spending patterns, and overheard conversations between adults. Child psychological outcomes included guilt, anxiety about money, and feelings of being a burden.

CONCLUSION

Pediatric oncology professionals and staff should be mindful of parent preferences about burdening children with sensitive financial information, and modify their behaviors and processes accordingly. They can also provide anticipatory guidance and psycho-education about psychological responses related to the effects of pediatric cancer on family finances and the role of cognitive development in the evolution of children's awareness of those effects.

Anti-Racism Strategies in Pediatric Psychology: Using STYLE Can Help Children Overcome Adverse Experiences With Police

Black children are exposed to police violence at alarming rates. Such stress impacts development and treatment of physical health problems. In the current discourse, we introduce STYLE (Self-examination, Talk about community-police relations and racism, Yield space and time to anti-racism work, Learn about how structural racism impacts child health, Evaluate policies and practices through an anti-racism lens). STYLE offers a framework through which professionals in pediatric psychology can engage in anti-racist work across contexts from clinical care to academic and advocacy settings. Pediatric psychologists have a responsibility to be on the frontline as interventionists, educators, researchers, organizers, and advocates for racial justice through anti-racism practices. The current paper introduces STYLE in clinical care, community service, training/supervision, and academic and advocacy contexts. Case examples are provided. Professionals in pediatric psychology must first focus on changing their STYLE to promote individual and infrastructural change consistent with anti-racism work.

Impact of the COVID-19 lockdown on screen media use in patients referred for ADHD to child and adolescent psychiatry: an introduction to problematic use of the internet in ADHD and results of a survey

The COVID-19 outbreak and lockdown have been associated with multiple consequences for mental health, including an excessive and potentially harmful increase in screen media use. The specific consequences for children, adolescents and young adults with ADHD are still unknown. In the first part of this study, a short review of problematic use of the internet (PUI) in ADHD is presented, showing that patients with ADHD are at risk for different aspects of PUI, such as excessive gaming or problematic social media use. In the second part, we report original data of an online survey on screen media use before, during and after the lockdown completed by parents of children and adolescents clinically referred for ADHD. Parents rated children's/adolescents' media-related behavior and media time on a new screening questionnaire for PUI. Each item was rated three times, referring to the observed behavior before, during and 1-2 months after the lockdown. N = 126 parents of patients referred for ADHD aged 10-18 years participated in the study. Total media time increased by 46% during the lockdown and did not completely return to pre-Corona levels afterwards. Patients with difficulties concentrating, high irritability or deterioration of ADHD problems under lockdown spent more time with screen media than those with milder or no such problems. While the effects of the lockdown on screen media use and its negative impact on everyday life appear to be largely reversible, a small proportion of patients with ADHD apparently continue to show increased media use.

Parental Mental Health and Children's Behaviors and Media Usage during COVID-19-Related School Closures

BACKGROUND

Coronavirus disease 2019 (COVID-19) is different from previous disasters in that it continues to the present and has affected all aspects of family life. During epidemics, psychosocial support is not less important than infection control. During COVID-19-related school closures, prolonged partial closures of schools could have detrimental social and health consequences for children and may increase the burden on the family. Based on a community sample in Korea, this study identified parental concerns, children's media usage, other various factors and examined whether parental stress level or depression were positively associated with problem behaviors, media exposure, and sleep problems of the primary school children during school closure under COVID-19.

METHODS

Participants were 217 parents residing in Suwon, South Korea, who had primary school children and responded to a web-based questionnaire on parental concerns from school closure under COVID-19, subjective stress, depression, whether having received mental health services, and family characteristics; children's sleep patterns, problem behaviors, media usage during the online-only class period, and changes in activity level following the pandemic.

RESULTS

During school closure, children gained body weight, spent less time in physical activities and more in media usage. Besides online learning content (97.2%), YouTube was highly used content (87.6%), and games followed (78.3%). Parental subjective stress index was highly associated with parental depression (Pearson correlation 0.439, P < 0.001), children's sleep problems (0.283, P < 0.001), tablet time (0.171, P = 0.012) and behavior problems (0.413, P < 0.001). Parental depression was associated with children's sleep problems (0.355, P < 0.001), TV time (0.153, P = 0.024), tablet time (0.159, P = 0.019), and behavior problems (0.524, P < 0.001). Parents who previously received mental services seemed to be more concerned about the problems their children already have getting worse because of COVID-19 than the disease itself. Children's sleep problem was associated with tablet (0.172, P = 0.011) and smartphone time (0.298, P < 0.001), but not its frequency.

CONCLUSION

During COVID-19-related school closures, many parents and children had various difficulties relating to mental health. Ongoing monitoring of mental health of high-risk groups and multiple support systems may need to be expanded to cover those parents having difficulty in caring for their children.

Childhood anxiety disorders prevalence in Saudi Arabia

Objectives:

To investigate the prevalence of childhood anxiety disorders in Saudi Arabia.

Methods:

We conducted a cross-sectional study, between September and November 2019, in Saudi Arabia. The study group included the parents of 468 primary school children, aged 6-12 years. Parents completed the Screen for Child Anxiety Related Disorders (SCARED) screening instrument, translated to Arabic. The measured outcome was the prevalence of childhood anxiety disorders, determined from the scores on the SCARED instrument.

Results:

Childhood anxiety disorders prevalence were as follows: 32.7% had one anxiety, 18.4% had 2, 10.9% had 3, 8.1% had 4, and 7.7% had 5. Of note, 22.2% of children did not have an anxiety disorder.

Conclusion:

Our results reveal a high prevalence of childhood anxiety disorders among primary school age children in Saudi Arabia. Based on these findings, conducting awareness campaigns and providing educational programs on childhood anxiety disorders might be important to improve the health outcomes of children.

Childcare support and child social development in Japan: investigating the mediating role of parental psychological condition and parenting style

In humans, support from partners and alloparents is crucial for successful child-rearing and optimal child development. However, the complex relationships among childcare support, children's outcomes and parental characteristics have not been fully examined. We investigate how three sources of partner and alloparental support-partner's childcare participation, support from children's grandparents and support from non-kin-can be associated with child social development. We hypothesize that the associations between childcare support from partners/alloparents and child social development are partly mediated by parental psychological condition and parenting style. To test this, we conducted path analyses on online survey data collected in 2016 from parents of 3- to 5-year-old children in Japan. We found no evidence that childcare support had direct positive effects on child social development. Rather, the benefit of childcare support was mediated by its effects on parental psychological condition and parenting style, which in turn improved children's outcomes. At the same time, we found some evidence that greater availability of childcare support was directly associated with more behavioural difficulties in children. Our findings reveal the complex pathways between childcare support, parental characteristics and children's outcomes in Japan, showing potential mechanisms behind parental and alloparental effects in industrialized populations. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.

"There's something inside": Children's intuitions about animate agents

From infancy, humans have the ability to distinguish animate agents from inert objects, and preschoolers map biological and mechanical insides to their appropriate kinds. However, less is known about how identifying something as an animate agent shapes specific inferences about its internal properties. Here, we test whether preschool children (N = 92; North American population) have specifically biological expectations about animate agents, or if they have more general expectations that animate agents should have an internal source of motion. We presented preschoolers with videos of two puppets: a "self-propelled" fur-covered puppet, and a fur-covered puppet that is seen to be moved by a human actor. In addition, we presented preschoolers with images of a familiar artifact (motorcycle) and familiar animal (sheep). For each item, we asked them to choose what they thought was inside each of these entities: nothing, biological insides, or mechanical insides. Preschoolers were less likely to say that a self-propelled fur-covered object was empty, compared to a fur-covered object that was moved by a human actor, which converges with past work with infants. However, preschoolers showed no specifically biological expectations about these objects, despite being able to accurately match biological insides to familiar animals and mechanical insides to familiar artifacts on the follow-up measure. These results suggest that preschoolers do not have specifically biological expectations about animate agents as a category, but rather general expectations that such agents should not be empty inside.

Global Burden of Violence

This article documents the increasing numbers of children impacted annually by 1 or more types of violence against children and describes the range of types of injuries and their immediate and long-term impacts on child outcomes. The article describes the growing number of international collaborations to decrease the numbers of children impacted by violence and to mitigate the consequences thereof, with a particular emphasis on children living in war zones.

K-12 School Shootings: Implications for Policy, Prevention, and Child Well-Being

Schools should be considered safe spaces for children; children need to feel secure in order to grow and learn. This article argues that when a school shooting occurs, the harm goes beyond those who are injured or killed, because the presumption of security is shattered, and the mental and emotional health of the students is threatened. There are many interventions for preventing these attacks at the school, state, and federal levels. This article explores evidence behind some of these interventions and describes the delicate balance in implementing interventions without introducing undue stress and anxiety into a child's everyday life.

COVID-19 pandemic impact on children and adolescents' mental health: Biological, environmental, and social factors

Since the Coronavirus disease 2019 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was announced, we had an unprecedented change in the way we organize ourselves socially and in our daily routine. Children and adolescents were also greatly impacted by the abrupt withdrawal from school, social life and outdoor activities. Some of them also experienced domestic violence growing. The stress they are subjected to directly impacts their mental health on account of increased anxiety, changes in their diets and in school dynamics, fear or even failing to scale the problem. Our aim is to bring up a discussion under different aspects and to alert public health and government agents about the need for surveillance and care of these individuals. We hope that the damage to their mental health as a result of the side effect of this pandemic can be mitigated by adequate and timely intervention.

Infants relax in response to unfamiliar foreign lullabies

Music is characterized by acoustic forms that are predictive of its behavioural functions. For example, adult listeners accurately identify unfamiliar lullabies as infant-directed on the basis of their musical features alone. This property could reflect a function of listeners' experiences, the basic design of the human mind, or both. Here, we show that US infants (N = 144) relax in response to eight unfamiliar foreign lullabies, relative to matched non-lullaby songs from other foreign societies, as indexed by heart rate, pupillometry and electrodermal activity. They do so consistently throughout the first year of life, suggesting that the response is not a function of their musical experiences, which are limited relative to those of adults. The infants' parents overwhelmingly chose lullabies as the songs that they would use to calm their fussy infant, despite their unfamiliarity. Together, these findings suggest that infants may be predisposed to respond to common features of lullabies found in different cultures.

Facing the real time challenges of the COVID-19 emergency for child neuropsychology service in Milan

BACKGROUND

In Italy, due to the COVID-19 emergency, hospitals and health services were required to undergo rapid changes in organization and assistance delivery in order to control the epidemic outbreak. The confinement of the population and the outbreak impact on health care systems disrupted the routine care for non COVID-19 patients. Particular challenges have been faced for services working with neurodevelopmental disabilities and pediatric neurological disorders. We present the adaptation of our Child Neurology and Developmental Neuropsychology Service at the Developmental Neurology Unit, which is responsible for cognitive and behavioral assessment of children with neurodevelopmental disorders and neurological diseases, on an inpatient/outpatient basis, to the epidemic outbreak. In particular, we describe the introduction of telehealth in clinical practice and provide qualitative and quantitative data regarding the feasibility of the telemedicine protocol and the level of satisfaction experienced by families.

OUTCOMES

Patients admitted on an inpatient basis are limited to non-deferrable cases; all patients do pre-admission screening to exclude COVID-19 infection. Child neurologists and psychologists have switched the out-patient visits to telemedicine sessions, despite they had little to no previous experience in telemedicine. Families' response to the proposal of video-sessions has been positive with 93 % of families accepting it, preparing appropriate devices and conditions to participate at home. Main barriers to tele-sessions access were socio-economic and linguistic disadvantage, together with familiar health issues. The Telemedicine Satisfaction Questionnaire revealed high level of agreementi between expected care and actual care received by patients and caregivers.

CONCLUSIONS

The experience of our Service confirms the importance of an inclusive response to emergency with respect to people with disabilities, ensuring the quality and continuity of care in times of population quarantine. Our experience could be useful worldwide to evaluate the feasibility of the Italian emergency response applied to the assistance of children with neurodevelopmental disabilities.

Breadwinners and Losers: Does the Mental Health of Mothers, Fathers, and Children Vary by Household Employment Arrangements? Evidence From 7 Waves of Data From the Longitudinal Study of Australian Children

In Australia, as in many industrialized countries, the past 50 years have been marked by increasing female labor-force participation. It is popularly speculated that this might impose a mental-health burden on women and their children. This analysis aimed to examine the associations between household labor-force participation (household employment configuration) and the mental health of parents and children. Seven waves of data from the Longitudinal Study of Australian Children were used, comprising 2004-2016, with children aged 4-17 years). Mental health outcome measures were the Strengths and Difficulties Questionnaire (children/adolescents) and 6-item Kessler Psychological Distress Scale (parents). A 5-category measure of household employment configuration was derived from parental reports: both parents full-time, male-breadwinner, female-breadwinner, shared-part-time employment (both part-time) and father full-time/mother part-time (1.5-earner). Fixed-effects regression models were used to compare within-person effects, controlling for time-varying confounders. For men, the male-breadwinner configuration was associated with poorer mental health compared with the 1.5-earner configuration (β = 0.21, 95% confidence interval: 0.05, 0.36). No evidence of association was observed for either women or children. This counters prevailing social attitudes, suggesting that neither children nor women are adversely affected by household employment configuration, nor are they disadvantaged by the extent of this labor-force participation. Men's mental health appears to be poorer when they are the sole household breadwinner.

Social communication deficits following early-life deprivation and relation to psychopathology: a randomized clinical trial of foster care

BACKGROUND

Children reared in institutions experience profound deprivation that is linked to impairments in social communication (SC). However, little is known about the long-term consequences of institutional rearing on SC through adolescence, and how SC deficits relate to broad-spectrum psychopathology. It is also unclear whether early removal from deprivation and placement into socially enriched environments remediates these difficulties.

METHODS

Children reared in Romanian institutions from the Bucharest Early Intervention Project were randomly assigned to care as usual or foster care intervention in early childhood. An age- and sex-matched group of never-institutionalized children was also recruited. SC data from 208 children at age 8 and 129 children at 16 were collected using the Social Communication Questionnaire. Psychopathology was assessed as saved factor scores for general (P) and specific internalizing (INT) and externalizing (EXT) problems. We examined (a) whether institutional rearing is associated with continued SC deficits into adolescence; (b) whether early placement into foster care mitigates risk for SC problems; and (c) associations between SC and psychopathology from middle childhood (age 8) to adolescence (age 16).

RESULTS

Findings suggest that: (a) institutionally-reared children have significantly more SC problems than never-institutionalized children at age 16; (b) children placed into foster care early in life have fewer problems with reciprocal social interaction compared to those with prolonged institutional rearing; and (c) deficits in SC at age 8 partially account for the link between institutional rearing and general psychopathology at age 16.

CONCLUSIONS

Early deprivation is associated with impairments in SC that persist into adolescence, with evidence for the remedial benefit of family-based care in the domain of reciprocal social interaction. Moreover, deficits in SC among ever-institutionalized children in middle childhood may increase the risk of broad-spectrum psychopathology in adolescence, thus providing one putative target for early intervention to safeguard against later psychiatric problems.

Do suicide rates in children and adolescents change during school closure in Japan? The acute effect of the first wave of COVID-19 pandemic on child and adolescent mental health

BACKGROUND

The coronavirus disease 2019 (COVID-19) has severely impacted the lives of children and adolescents. School closure, one of the critical changes during the first COVID-19 wave, caused decreases in social contacts and increases in family time for children and adolescents. This can have both positive and negative influences on suicide, which is one of the robust mental health outcomes. However, the impact of the COVID-19 crisis on children and adolescents in terms of suicide is unknown.

OBJECTIVE

This study investigates the acute effect of the first wave of the COVID-19 pandemic on suicide among children and adolescents during school closure in Japan.

DATA

Total number of suicides per month among children and adolescents under 20 years old between January 2018 and May 2020.

METHODS

Poisson regression was used to examine whether suicide increased or decreased during school closure, which spanned from March to May 2020, compared with the same period in 2018 and 2019. Robustness check was conducted using all data from January 2018 to May 2020. Negative binomial regression, a model with overdispersion, was also performed.

RESULTS

We found no significant change in suicide rates during the school closure (incidence rate ratio (IRR) = 1.15, 95% confidence interval (CI): 0.81 to 1.64). We found the main effect of month, that is, suicides significantly increased suicides in May (IRR: 1.34, 95% CI: 1.01 to 1.78) compared to March, but the interaction terms of month and school closure were not significant (p > 0.1).

CONCLUSIONS

As preliminary findings, this study suggests that the first wave of the COVID-19 pandemic has not significantly affected suicide rates among children and adolescents during the school closure in Japan.

The nature of posttraumatic nightmares and school functioning in war-affected youth

Children and adolescents who have experienced traumatic events demonstrate a variety of posttraumatic symptoms, including recurrent nightmares, as well as adverse reactions in the school setting. The current study examined nightmare symptoms, posttraumatic stress, sleep disturbance, and self- and teacher-reported school functioning of 64 youths in the Gaza Strip, ages 12 to 16, who have lived through three wars and experience ongoing conflict and political insecurity. Students were treatment-seeking for sleep-problems and reported, on average, five nightmares per week for an average of three years, with concomitant disrupted sleep, fear of going to sleep, and not feeling rested in the morning. Both teachers and students reported that participants exhibited impaired academic functioning and daytime sleepiness. The content of the students’ nightmares demonstrated frightening themes of being under attack and loss of self-efficacy/control; threat levels were high, and almost 60% included the threat of death. Approximately half of the nightmares included surreal elements in addition to more realistic scenes of violence. Participants in the study demonstrated substantial posttraumatic sleep problems with intensely distressing, frequent and chronic nightmares, andnightmare symptoms were associated with impairment in school functioning. Given the disruptive and distressing nature of these students’ nightmare disturbance, we suggest that increasing self-efficacy in relation to the experience of recurrent nightmares may be a good point of intervention with these recurrently traumatized youth. Thus, increasing the understanding of students’ nightmare symptoms may lead to ameliorating the suffering of youths in war zones and may have positive effects on their school functioning.