Posttraumatic stress disorder in infants and young children exposed to war-related trauma

Maternal Perceptions and Responsiveness to Cry in Armed Conflict Zones: Links to Child Behavior Problems

Crying is a typical infant behavior that activates parental caregiving behaviors, acting as "human alarms" important for the infant's survival. When living under war-related threat, the auditory system may be sensitized given its importance for survival, potentially impacting maternal cry processing. Children living in armed-conflict zones are at increased risk for behavior problems, which may relate to both direct exposure and indirect effects through their parents' perceptions and behaviors. This hypothesis was examined in a sample of mothers and their first-born children (aged 10-45 months) living in the Gaza vicinity area in Israel, chronically exposed to missile alarms (high-exposure; n = 45), and a comparison group (low-exposure; n = 86). Group differences in child behavior problems and maternal perceptions of and responsiveness to cry were investigated. A moderated indirect-effect of maternal cry perceptions on child behavior problems via maternal responsiveness to cry was examined. In the high-exposure group, children had more externalizing problems and mothers rated cries as more aversive. Maternal cry perception was indirectly related to child behavior problems via responsiveness to cry only in the high-exposure group: higher perceptions of cry as aversive or the child as distressed were related to faster responding to crying, and faster cry responsiveness was linked with fewer behavior problems. Results suggest that in armed-conflict zones with auditory warning signals, the parental caring system may be easily activated by cries due to the strong association between alarms and threat. Furthermore, children may need their mothers to react faster when feeling distressed, possibly because of the surrounding threat.

Trauma-sensitive school concepts for students with a refugee background: a review of international studies

Children and adolescents with a refugee background are at high risk for traumatization. Once they arrive in safe countries, schools are the institutions where teachers are responsible for caring for them sensitively and competently. Furthermore, schools are organized in learning groups consisting of multiple peers of the same age, which provides excellent opportunities for social learning and experiences of social support. In this respect, schools are the appropriate places where preventive concepts can be applied to students with a refugee background. This systematic review summarizes studies that examine or evaluate existing international concepts of trauma-sensitive schools for supporting traumatized students with a refugee background. Based on N = 41 selected articles, 17 relevant concepts of trauma-sensitive schools were identified. In 35.3% of the concepts, traumatized students with a refugee background are explicitly included in the target group of the concept, while 47.1% of the concepts refer to groups of students with trauma as a result of various adverse childhood experiences, which also occur more frequently within the population of refugee children and adolescents 17.6% of the concepts contain specific adaptations for pupils with a refugee background. The majority of these concepts were developed in the United States. Additional concepts can be reported for Australia, the United Kingdom, Turkey, and Cambodia. Based on available empirical data, no significant effectiveness regarding the researched concepts' effects on academic and other school-related data can be determined. Although some studies indicate positive effects concerning school-related target variables, most of the studies have only limited significance due to inadequate research designs and methodological deficiencies. Therefore, there is a great need for further development, careful implementation, and evaluation of trauma-sensitive concepts in schools, especially for the growing group of refugee students.

Parent-child interactive behavior in a German sample of parents with and without a mental illness: model replication and adaption of the Coding Interactive Behavior system

Studies using observational measures often fail to meet statistical standards for both reliability and validity. The present study examined the psychometric properties of the Coding Interactive Behavior (CIB) System within a German sample of parent-child dyads. The sample consisted of 149 parents with and without a mental illness and their children [n experimental group (EG) = 75, n control group (CG) = 74] who participated in the larger Children of Mentally Ill Parents at Risk Evaluation (COMPARE) study. The age of the children ranged from 3 to 12 years (M = 7.99, SD = 2.5). Exploratory factor analysis supported a five-factor model of the CIB with items describing 1) parental sensitivity/reciprocity, 2) parental intrusiveness, 3) child withdrawal, 4) child involvement, and 5) parent limit setting/child compliance. Compared to international samples, the model was reduced by two independent dyadic factors. Testing for predictive validity identified seven items with predictive power to differentiate parental group membership. The CIB factors did not seem to be sufficiently sensitive to illustrate differences in interaction within a sample of parents with various mental illnesses. To apply the CIB to the described sample or similar ones in the future, additional measurement instruments may be necessary.

Moving Forward in Mental Health Care for Refugee, Asylum-Seeking, and Undocumented Children: Social Determinants, Phased Approach to Care, and Advocacy

Given the current political and climate crisis, the number of forcedly displaced individuals continues to rise, posing new challenges to host societies aiming to support and respond to the needs of those fleeing war or persecution. In this article, we turn our attention to current and historical sociopolitical contexts influencing the mental health of forcedly displaced children (ie, refugee, asylum-seeking, and undocumented) during their resettlement in high-income countries, proposing timely ways to respond to evolving needs and recommendations to redress ubiquitous structural inequities that act as barriers to education and care for the children, youth, and families seeking sanctuary.

Evaluating caregiver-child interactions in low- and middle-income countries: a systematic review of tools and methods

AIMS/BACKGROUND

The United Nations Sustainable Development Goals (SDGs) has placed emphasis on improving early child development globally. This is supported through the Nurturing Care Framework which includes responsive caregiving. To evaluate responsive caregiving, tools to assess quality of caregiver-child interactions are used, however there is little information on how they are currently employed and/or adapted particularly in low- and middle-income countries (LMICs) where children have a greater risk of adverse outcomes. The aim of this review is to provide a comprehensive guide on methodologies used to evaluate caregiver-child interaction - including their feasibility and cultural adaptation.

DESIGN/METHODS

We conducted a systematic review of studies over 20years in LMICs which assessed caregiver-child interactions. Characteristics of each tool, their validity (assessed with COSMIN Risk of Bias checklist), and the quality of the study (Mixed Methods Appraisal Tool) are reported.

RESULTS

We identified 59 studies using 34 tools across 20 different LMICs. Most tools (86.5%) employed video-recorded observations of caregiver-child interactions at home (e.g. Ainsworth's Sensitivity Scale, OMI) or in the laboratory (e.g. PICCOLO) with a few conducting direct observations in the field (e.g. OMCI, HOME); 13.5% were self-reported. Tools varied in methodology with limited or no mention of validity and reliability. Most tools are developed in Western countries and have not been culturally validated for use in LMIC settings.

CONCLUSION

There are limited caregiver-child interaction measures used in LMIC settings, with only some locally validated locally. Future studies should aim to ensure better validity, applicability and feasibility of caregiver-child interaction tools for global settings.

Caregiving relationships are a cornerstone of developmental psychopathology

The interdisciplinary field of developmental psychopathology has made great strides by including context into theoretical and empirical approaches to studying risk and resilience. Perhaps no context is more important to the developing child than their relationships with their caregivers (typically a child's parents), as caregivers are a key source of stimulation and nurturance to young children. Coupled with the high degree of brain plasticity in the earliest years of life, these caregiving relationships have an immense influence on shaping behavioral outcomes relevant to developmental psychopathology. In this article, we discuss three areas within caregiving relationships: (1) caregiver-child interactions in everyday, naturalistic settings; (2) caregivers' social cognitions about their child; and (3) caregivers' broader social and cultural context. For each area, we provide an overview of its significance to the field, identify existing knowledge gaps, and offer potential approaches for bridging these gaps to foster growth in the field. Lastly, given that one value of a scientific discipline is its ability to produce research useful in guiding real-world decisions related to policy and practice, we encourage developmental psychopathology to consider that a focus on caregiving, a modifiable target, supports this mission.

Associations of Warzone Veteran and Intimate Partner PTSD Symptoms with Child Depression, Anxiety, Hyperactivity, and Conduct Problems

Warzone deployment increases risk for posttraumatic stress disorder symptoms (PTSS), including among service members who have children. Parental PTSS are associated with child depression, anxiety, hyperactivity, and conduct problems, yet few studies of child behavioral health outcomes in military populations have accounted for PTSS in both warzone veterans and their partners. Fewer still incorporate non-clinically-recruited samples of nationally dispersed warzone veterans and their families. The current research examines whether children whose parent(s) have higher levels of PTSS exhibit more behavioral health symptoms. One hundred and thirty-three Iraq and Afghanistan War veterans and their cohabitating partners completed clinical interviews and self-report questionnaires. Higher intimate partner PTSS, more extensive child exposure to stressful life events, and being an adolescent were significantly associated with child depression after adjusting for warzone veteran PTSS, demographics, and recent warzone veteran absence from the household. Greater child exposure to stressful life events was also associated with child conduct problems. Treatment of PTSD symptoms experienced by warzone veterans' intimate partners, and preventative interventions aimed at helping the children of warzone veterans cope with stress, may ultimately yield positive benefits for the behavioral health of children in military families.

A Scientometric Review of Infant Cry and Caregiver Responsiveness: Literature Trends and Research Gaps over 60 Years of Developmental Study

Infant cry is an adaptive signal of distress that elicits timely and mostly appropriate caring behaviors. Caregivers are typically able to decode the meaning of the cry and respond appropriately, but maladaptive caregiver responses are common and, in the worst cases, can lead to harmful events. To tackle the importance of studying cry patterns and caregivers' responses, this review aims to identify key documents and thematic trends in the literature as well as existing research gaps. To do so, we conducted a scientometric review of 723 documents downloaded from Scopus and performed a document co-citation analysis. The most impactful publication was authored by Barr in 1990, which describes typical developmental patterns of infant cry. Six major research thematic clusters emerged from the analysis of the literature. Clusters were renamed "Neonatal Pain Analyzer" (average year of publication = 2002), "Abusive Head Trauma" (average year of publication = 2007), "Oxytocin" (average year of publication = 2009), "Antecedents of Maternal Sensitivity" (average year of publication = 2010), "Neurobiology of Parental Responses" (average year of publication = 2011), and "Hormonal Changes & Cry Responsiveness" (average year of publication = 2016). Research clusters are discussed on the basis of a qualitative inspection of the manuscripts. Current trends in research focus on the neurobiology of caregiver responses and the identification of factors promoting maternal sensitivity. Recent studies have also developed evidence-based strategies for calming crying babies and preventing caregivers' maladaptive responses. From the clusters, two topics conspicuously call for future research: fathers' responsiveness to infant cry and the impact of caregiver relationship quality on cry responsiveness.

Impact of war and forced displacement on children's mental health-multilevel, needs-oriented, and trauma-informed approaches

The infliction of war and military aggression upon children must be considered a violation of their basic human rights and can have a persistent impact on their physical and mental health and well-being, with long-term consequences for their development. Given the recent events in Ukraine with millions on the flight, this scoping policy editorial aims to help guide mental health support for young victims of war through an overview of the direct and indirect burden of war on child mental health. We highlight multilevel, need-oriented, and trauma-informed approaches to regaining and sustaining outer and inner security after exposure to the trauma of war. The impact of war on children is tremendous and pervasive, with multiple implications, including immediate stress-responses, increased risk for specific mental disorders, distress from forced separation from parents, and fear for personal and family's safety. Thus, the experiences that children have to endure during and as consequence of war are in harsh contrast to their developmental needs and their right to grow up in a physically and emotionally safe and predictable environment. Mental health and psychosocial interventions for war-affected children should be multileveled, specifically targeted towards the child's needs, trauma-informed, and strength- and resilience-oriented. Immediate supportive interventions should focus on providing basic physical and emotional resources and care to children to help them regain both external safety and inner security. Screening and assessment of the child's mental health burden and resources are indicated to inform targeted interventions. A growing body of research demonstrates the efficacy and effectiveness of evidence-based interventions, from lower-threshold and short-term group-based interventions to individualized evidence-based psychotherapy. Obviously, supporting children also entails enabling and supporting parents in the care for their children, as well as providing post-migration infrastructures and social environments that foster mental health. Health systems in Europe should undertake a concerted effort to meet the increased mental health needs of refugee children directly exposed and traumatized by the recent war in Ukraine as well as to those indirectly affected by these events. The current crisis necessitates political action and collective engagement, together with guidelines by mental health professionals on how to reduce harm in children either directly or indirectly exposed to war and its consequences.

When COVID-19 Met Families Living in Armed-Conflict Zones: The Importance of Maternal Trauma and Child Self-Regulation

The COVID-19 outbreak began in Israel at the end of February 2020, and on March 17, 2020, a general lockdown was announced. Families were instructed to stay at home and schools and non-essential businesses were closed. Aiming to understand how families who were already living in areas of high exposure to armed conflict would be affected by another external stressful condition, data were collected before and after the outbreak. Mothers and children (aged 10-45 months) were recruited from areas with high (n = 40) and low (n = 78) exposure to armed conflict. Mothers reported on their posttraumatic stress symptoms (PTSS) and on their child's effortful control tendencies prior to the outbreak. Toward the end of the first lockdown, mothers were interviewed regarding adverse effects of the outbreak on their family. No group differences were found for maternal perceptions of adverse effects of COVID-19. However, a moderation model was revealed, indicating that maternal PTSS as well as child effortful control predicted adverse effects of COVID-19 only in the high-exposure group. Results are discussed considering cumulative stress and risk factors.

From mothers to children and back: Bidirectional processes in the cross-generational transmission of anxiety from early childhood to early adolescence

BACKGROUND

Maternal psychopathology and caregiving behavior are linked with child anxiety and these associations may be particularly salient when families face mass trauma together and members influence each other's symptomatology and resilience. Despite the well-known mother-to-child effects, less research addressed the longitudinal bidirectional effects of maternal and child's anxiety symptoms on each other.

METHODS

Mothers and children exposed to chronic war-related trauma from Sderot, Israel, and comparison group were followed at three time-points; Early childhood (T1:N = 232, M_Age  = 2.76 years), late childhood (T3:N = 176, M_Age  = 9.3 years), and early adolescence (T4:N = 110, M_Age  = 11.66 years). At each time-point maternal and child's anxiety symptoms were evaluated via questionnaires and maternal sensitivity was coded from videotaped observations of parent-child interactions. Bidirectional associations were examined using traditional cross-lagged panel model (CLPM) and CLPM with random intercepts (RI-CLPM).

RESULTS

Trauma-exposed mothers and children exhibited more anxiety symptoms and lower maternal sensitivity. Cross-lagged panel models revealed cross-time bidirectional associations between maternal anxiety and child anxiety from early to late childhood. Child anxiety at each time-point predicted maternal anxiety and maternal sensitivity at the next stage; however, maternal sensitivity did not show longitudinal associations with child anxiety, highlighting children's role in shaping caregiving.

CONCLUSIONS

Findings demonstrate bidirectional cross-generational influences of mother and child on each other's anxiety in contexts of trauma and pinpoint early childhood as a sensitive period for such mutual influences. Children's increased anxiety following trauma appears to be further exacerbated via its impact on increasing maternal anxiety and compromising sensitive caregiving, underscoring the potential benefits of parental and mother-child interventions for trauma-exposed populations.

An overview of the mental and physical health status and post-migration psychosocial stressors of refugee toddlers and preschoolers

PURPOSE

Although thousands of refugee children are being born in resettlement areas, few studies have described the mental and physical status in early childhood. We aimed to study the mental, physical status, and post-migration psychosocial stressors of refugee toddlers and preschoolers.

DESIGN AND METHODS

The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood was used to assess psychiatric disorders, parent-child relational context, physical health conditions, psychosocial and environmental stressors, and developmental competencies of children who were evaluated at the clinic site. This study was a retrospective examination of these health records. Seventy participants were divided into two groups: children born during resettlement in Turkey and children born in Syria. The Syria group consisted of 33 participants aged 66.73 ± 13.05 months. The Turkey group consisted of 37 participants aged 38.78 ± 16.82 months.

FINDINGS

In both groups, children suffered from a wide range of mental and physical disorders and a variety of psychosocial stressors. Monthly income and resettlement time in the Turkey group were more statistically significant (χ²  = 10.611, p = 0.014; χ²  = 5.976, p = 0.050). Also in the Turkey group, parents and siblings had significantly more mental health problems (χ²  = 4.39, p = 0.04; χ²  = 5.38, p = 0.02).

PRACTICE IMPLICATIONS

Child and adolescent mental health workers need to be aware of the specific needs of this particular age group of refugees. Social, economic, and policy efforts are needed to improve the living conditions of refugee children.

Social Behavior as a Transdiagnostic Marker of Resilience

The recent shift from psychopathology to resilience and from diagnosis to functioning requires the construction of transdiagnostic markers of adaptation. This review describes a model of resilience that is based on the neurobiology of affiliation and the initial condition of mammals that mature in the context of the mother's body and social behavior. The model proposes three tenets of resilience-plasticity, sociality, and meaning-and argues that coordinated social behavior stands at the core sustaining resilience. Two lines in the maturation of coordinated social behavior are charted, across animal evolution and throughout human development, culminating in the mature human reciprocity of empathy, mutuality, and perspective-taking. Cumulative evidence across ages and clinical conditions and based on our behavioral coding system demonstrates that social reciprocity, defined by plasticity at the individual, dyadic, and group levels, denotes resilience, whereas the two poles of disengagement/avoidance and intrusion/rigidity characterize specific psychopathologies, each with a distinct behavioral signature. Attention to developmentally sensitive markers and to the dimension of meaning in human sociality may open new, behavior-based pathways to resilience.

Physiological and social synchrony as markers of PTSD and resilience following chronic early trauma

OBJECTIVE

Although resilience is a key topic in clinical theory and research, few studies focused on biobehavioral mechanisms that underpin resilience. Guided by the biobehavioral synchrony frame, we examined the dynamic interplay of physiological and behavioral synchrony as marker of risk and resilience in trauma-exposed youth.

METHODS

A unique cohort of war-exposed versus control children was followed at four time-points from early childhood to preadolescence and child posttraumatic stress disorder (PTSD) repeatedly assessed. At preadolescence (11-13 years), mother and child were observed in several social and nonsocial tasks while cardiac data collected and measures of respiratory sinus arrhythmia (RSA) and RSA synchrony computed. The social interactive task was microcoded for behavioral synchrony and the second-by-second balance of behavioral and physiological synchrony was calculated. War-exposed preadolescents were divided into those diagnosed with PTSD at any time-point across childhood versus resilient children.

RESULTS

Group differences in behavioral synchrony, RSA synchrony, and their interplay emerged. PTSD dyads exhibited the tightest autonomic synchrony combined with the lowest behavioral synchrony, whereas resilient dyads displayed the highest behavioral and lowest autonomic synchrony. Hierarchical Linear Model analysis pinpointed two resilience-promoting mechanisms. First, for resilient and control dyads, moments of behavioral synchrony were coupled with decreased RSA synchrony. Second, only among resilient dyads, moments of behavioral synchrony increased child RSA levels.

CONCLUSION

Findings specify mechanisms by which biobehavioral synchrony promotes resilience. As children grow, the tightly coupled mother-child physiology must be replaced by loosely coordinated behavioral attunement that buttresses maturation of the child's allostatic self-regulation. Our findings highlight the need for synchrony-based interventions to trauma-exposed mothers.

Multiple Traumas, Maternal Depression, Mother-Child Relationship, Social Support, and Young Children's Behavioral Problems

This study examined whether maternal depression, mother-child relationships, and maternal perceived social support mediate the associations between child's exposure to multiple traumatic events and behavioral problems. We recruited a representative sample of 904 Israeli (Jewish and Arab) mothers and their 2- to 6-year-old children. Data collection was conducted through structured face-to-face interviews with the mothers between July and November 2011. All measures were completed by the mothers. We used the child's and mother's exposure to political violence questionnaires, Child Behavior Checklist (CBCL), a short version of the Parental Acceptance-Rejection Questionnaire (PARQ), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Medical Outcomes Study (MOS) Social Support Survey. The research study model was tested using path analysis. The model showed a very good fit to the data, suggesting that maternal rejection, maternal depression, and social support play an important role in child's behavioral problems in the context of multiple traumatic events. Higher levels of maternal rejection were significantly associated with greater children behavior problems. Maternal rejection mediated the associations between maternal depressive symptoms and child's behavioral problems. Maternal perceived social support mediated the associations between child's exposure to multiple traumatic events and child's behavioral problems; child's exposure to multiple traumatic events was associated with lower levels of maternal perceived social support. In turn, lower levels of perceived social support were associated with higher levels of behavioral problems. In conclusion, in accordance with the "social stress framework," social support has a mediation role in the association between exposure to traumatic events and child's behavioral problems. Thus, enhancing social support to mothers to young children in the context of multiple traumatic events is essential for children resiliency.

The Differential Effects of Insecure Attachment on Post-Traumatic Stress: A Systematic Review of Extant Findings and Explanatory Mechanisms

It is well-documented that insecure attachment poses substantial risks to post-trauma recovery. Although attachment anxiety reliably predicts and is associated with elevated post-traumatic stress symptoms (PTSS), the attachment avoidance-PTSS link has been far less consistent. This suggests both attenuating and enhancing connections between attachment difficulties and post-trauma outcomes. The goal of this study is 2-fold: (a) to review and summarize extant evidence concerning the relation between insecure attachment and PTSS and (b) to review mechanism(s) underlying attachment anxiety and attachment avoidance that may explain the development of PTSS. Following a systematic review of the empirical literature investigating attachment, trauma, and post-trauma reactions, a total of 138 studies were identified and summarized. The review further identifies explanatory mechanisms underlying the association between insecure attachment and PTSS, including stress appraisals, cognitive factors, self-esteem, emotion regulation strategies, social factors, and trauma-specific factors (i.e., type of trauma, extreme stress). Implications for practice, policy, and research are discussed.

The Dimensionality of Proposed DSM-5 PTSD Symptoms in Trauma-Exposed Young Children

A subtype of the posttraumatic stress disorder diagnosis for children 6 years and younger (PTSD-6Y) was introduced in the Diagnostic and Statistical Manual, Fifth Edition (DSM-5). This study utilized confirmatory factor analytic techniques to evaluate the proposed DSM-5 PTSD-6Y factor structure and criterion and convergent validity against competing models. Data for N = 284 (3–6 years) trauma-exposed young children living in New Orleans were recruited following a range of traumas, including medical emergencies, exposure to Hurricane Katrina and repeated exposure to domestic violence. The model was compared to DSM-IV, a 4-factor ‘dysphoria’ model that groups symptoms also associated with anxiety and depression, and alternate 1- and 2- factor models. Convergent validity was established against the Child Behavior Checklist (CBCL). Criterion related validity was established by comparing each model to a categorical rating of impairment. The Dysphoria and PTSD-6Y models offered the better accounts of symptom structure, although neither satisfied minimum requirements for a good fitting model. These two models also only showed small levels of convergence with CBCL dimensions. The 1-factor model offered the most compelling balance of sensitivity and specificity, with the 2-factor model and the Dysphoria model following closely behind. These CFA results do not support the symptom clusters proposed within the DSM-5 for PTSD-6Y. Although a 4-factor Dysphoria model offers a better overall account of clustering patterns (relative to alternate models), alongside acceptable sensitivity and specificity for detecting clinical impairment, it also falls short of being an adequate model in this younger age group.

Social and emotional contexts predict the development of gaze following in early infancy

The development of gaze following begins in early infancy and its developmental foundation has been under heavy debate. Using a longitudinal design (N = 118), we demonstrate that attachment quality predicts individual differences in the onset of gaze following, at six months of age, and that maternal postpartum depression predicts later gaze following, at 10 months. In addition, we report longitudinal stability in gaze following from 6 to 10 months. A full path model (using attachment, maternal depression and gaze following at six months) accounted for 21% of variance in gaze following at 10 months. These results suggest an experience-dependent development of gaze following, driven by the infant's own motivation to interact and engage with others (the social-first perspective).

EMDR therapy in children and adolescents who have post-traumatic stress disorder: a six-week follow-up study

Objectives: The purpose of this study is to explore whether eye movement desensitisation and reprocessing (EMDR) is an effective therapy and to investigate whether EMDR affects anxiety levels for children and adolescents.Methods: We conducted this study with 30 clients. The clients completed self-administered questionnaires Child Post-Traumatic Stress Reaction Index Scale and The State-Trait Anxiety Inventory. The questionnaires were conducted before the therapy and 6 weeks after the completion of the therapy.Results: Nineteen clients (63%) had only one traumatic event, but 11 clients (37%) had more than one traumatic event. While the mean score on the PTSD symptom scale was 60 (±8.7), this rate decreased to 24 (±10.1), whereas the mean STAI-T scale was 59 (±8.9) before treatment and 41 (±11.5) after treatment. We found a statistically significant difference between symptom scores as quantified by both questionnaires before and after EMDR therapy (p < .05).Conclusions: As a result, we have shown that EMDR is an effective method for children and adolescents with PTSD in terms of both post-traumatic and anxiety symptom levels; however, we recommend a larger sample size with a control group to further establish the effectiveness of EMDR therapy in children.KEY POINTSPTSD is a common disorder in children and adolescents.Additional psychiatric disorders such as anxiety and depression are common in children and adolescents with PTSD.In PTSD cases applying for psychiatric treatment, trauma associated with sexual abuse is more pronounced and complex.EMDR is an effective therapy in children and adolescents as well as in adults.There is a statistically significant decrease at anxiety and PTSD symptom scores as quantified by questionnaires in patients with PTSD after EMDR therapy.

Sensory Modulation in Children Exposed to Continuous Traumatic Stress

Preliminary evidence supports a possible association between post-traumatic stress disorder (PTSD) and sensory modulation disorder (SMD). Nevertheless, the research focusing on this relationship in children is notably limited. This study examined children with and without PTS symptoms, by comparing their mothers' perceptions of their responses to sensory events in daily life. Mothers of 134 non-referred children aged 5-11, exposed to continuous traumatic stress due to political violence, completed the UCLA-RI and the Short Sensory Profile questionnaires. Significant differences emerged between children with different levels of PTS symptoms in various sensory modalities. Furthermore, half of the symptomatic children had suspected clinically significant deficits in sensory processing. In addition, PTSD symptoms were significantly associated with most of the sensory processing scores. Logistic regression indicated that the overall sensory processing score was a significant predictor of group classification. The results indicate that children with PTS symptoms may be at increased risk for sensory processing deficits. Evaluation of sensory processing should be incorporated into the routine evaluation of this population in order to determine whether this is an additional factor contributing to a child's difficulties in participating in daily activities. Subsequent intervention programs should then address the multiple needs of these children.

Mental Health Problems of Syrian Refugee Children: Post-Traumatic Stress, Depression and Anxiety

PURPOSE

This study aims to examine the levels of post-traumatic stress, depression and anxiety in Syrian children who live in refugee camps.

DESIGNS AND METHODS

This descriptive and correlational study was conducted using the Child Post-Traumatic Stress Reaction Index (CPTS-RI), the State-Trait Anxiety Inventory for Children-Trait Form (STAIC-Trait Form) and the Children's Depression Inventory (CDI). The study sample included 1115 Syrian refugee children.

RESULTS

The mean age of refugee children was 10.53 ± 2.79 years. Of them, 52% were males and 38% had no diseases while 74% were smokers and smoked 8.39 ± 6.85 cigarettes per day. The children's mean score on CPTS-RI, STAIC-Trait Form and CDI was found to be 60.59 ± 14.50, 54.11 ± 14.55 and 47.57 ± 10.97, respectively. The regression analysis revealed that anxiety and depression had a statistically significant association with post-traumatic stress.

CONCLUSIONS

The study findings revealed that refugee children have physical and psychosocial health problems and experience a high level of post-traumatic stress, depression and anxiety.

PRACTICE IMPLICATIONS

In this context, the study recommends that nursing practices should be developed considering that children may have mental health problems due to war.

Cumulative Risk on Oxytocin-Pathway Genes Impairs Default Mode Network Connectivity in Trauma-Exposed Youth

Background: Although the default mode network (DMN) is a core network essential for brain functioning, little is known about its developmental trajectory, particularly on factors associated with its coherence into a functional network. In light of adult studies indicating DMN's susceptibility to stress-related conditions, we examined links between variability on oxytocin-pathway genes and DMN connectivity in youth exposed to chronic war-related trauma Methods: Following a cohort of war-exposed children from early childhood, we imaged the brains of 74 preadolescents (age 11-13 years; 39 war-exposed) during rest using magnetoencephalography (MEG). A cumulative risk index on oxytocin-pathway genes was constructed by combining single nucleotide polymorphisms on five genes previously linked with social deficits and psychopathology; OXTR rs1042778, OXTR rs2254298, OXTRrs53576, CD38 rs3796863, and AVPR1A RS3. Avoidant response to trauma reminders in early childhood and anxiety disorders in late childhood were assessed as predictors of disruptions to DMN theta connectivity. Results: Higher vulnerability on oxytocin-pathway genes predicted greater disruptions to DMN theta connectivity. Avoidant symptoms in early childhood and generalized anxiety disorder in later childhood were related to impaired DMN connectivity. In combination, stress exposure, oxytocin-pathway genes, and stress-related symptoms explained 24.6% of the variance in DMN connectivity, highlighting the significant effect of stress on the maturing brain. Conclusions: Findings are the first to link the oxytocin system and maturation of the DMN, a core system sustaining autobiographical memories, alteration of intrinsic and extrinsic attention, mentalization, and sense of self. Results suggest that oxytocin may buffer the effects of chronic early stress on the DMN, particularly theta rhythms that typify the developing brain.

How do Syrian refugee children in Turkey perceive relational factors in the context of their mental health?

Although there has been increasing attention on the impact of risk and resilience factors on refugee children's mental health, there has been limited evidence on the role of parental factors to inform interventions, and this predominantly relies on adult reports. The aim was to investigate the relationship between perceived parenting styles and attachment relationships and child mental health, as reported by 322 Syrian refugee minors aged between 8 and 17 years in Turkey. Child-rated scales included the Children Revised Impact of Event Scale-8 (CRIES-8), Strengths and Difficulties Questionnaire (SDQ), Security Scale and Egna Minnen Betraffande Uppfostran for Children (EMBU-C), and were used as measures of post-traumatic stress disorder (PTSD), general mental health problems, attachment relationships and perceived parenting styles, respectively. Children with secure maternal and paternal attachment perceived their parents as less rejecting, while children with secure paternal attachment also reported their parents as emotionally warmer. Attachment relationships significantly contributed in predicting PTSD after controlling for age and gender, while conduct problems were predicted by lack of emotional warmth, rejection and over-protection by both parents, in addition to insecure attachment relationships. Refugee children's views are essential in establishing their needs and planning interventions. These should address both the impact of trauma and current family relationships.

Overview of Children and Disasters

Currently, throughout the world, there are nearly 40 million children displaced by natural or man-made disasters. The special needs of children in disasters are often unrecognized, yet children comprise half of disaster victims. The purpose of this review is to provide information on (1) demographics related to children and disasters, both domestic and international; (2) risks for children who experience disasters; (3) programs that help children in disasters; and (4) training programs on the special needs of children in disasters. Children who are displaced by disasters are at risk of acute and long-term medical problems. Disaster experiences can also lead to acute and long-term psychological problems. Ultimately, these have worldwide negative implications for human society, including education, health care, security, and economic and political aspects of daily life. There is a compelling need for more services to help the children who have experienced disasters and for education to train more relief workers about the special needs of children in disasters.

Determination of psychosocial conditions of refugee children living in society

PURPOSE

This study aims to determine the psychosocial conditions of refugee children living in society.

DESIGNS AND METHODS

This descriptive cross-sectional research which used the Socio-demographic Information Form for Children, Child Posttraumatic Stress Reaction Index (CPTS-RI), and Children's Depression Inventory (CDI) included 738 children.

RESULTS

Social factors like the educational levels and professions of their parents, as well as economic status could affect the children's level of posttraumatic stress disorder, depression, and anxiety. The regression analysis revealed that depression and anxiety explained 72% of posttraumatic stress disorder in the children studied.

PRACTICE IMPLICATIONS

Nurses should be aware that the effects of trauma on children who were exposed to war and migration can continue even after much time has passed since the war started.

Posttraumatic stress disorder and psychosocial difficulties among children living in a conflict area of the Southeastern Anatolia region of Turkey

BACKGROUND

Traumatic events and armed conflicts can lead to many mental disorders, especially posttraumatic stress disorder (PTSD), in children. We investigated the PTSD symptoms, psychosocial difficulties, general health levels of the parents, and direct and indirect effects of trauma on psychological outcomes.

MATERIALS AND METHODS

A total of 482 children were included in the study. Two hundred and eight of those children were from Derik district, where street fights, curfews, and conflict have been experienced, and 274 of those children were from Yeşilli district, where no conflicts have been observed despite being in the same province. All children filled out the child posttraumatic stress disorder reaction index, the strengths and difficulties questionnaire (SDQ), and parents filled out the General Health Questionnaire-12 (GHQ).

RESULTS

All children showed moderate PTSD symptoms; however, no significant difference was observed between the two groups. In the exposed group, children, who had to leave their homes for a while due to conflicts, had worse PTSD symptoms, higher SDQ difficulty scores, and parents' GHQ scores. It was determined that being a female having high maternal GHQ scores and leaving home due to the conflicts significantly increase the risk of occurrence of trauma symptoms.

CONCLUSION

Our findings suggest that children are susceptible to the direct and indirect effects of trauma. It is crucial for intervention programs to be developed for the detection, prevention, and treatment of PTSD symptoms to be applied to all children, regardless of exposure type, in areas affected by conflict.

WAIMH position paper: Infants' rights in wartime

The World Association for Infant Mental Health (WAIMH) decided to compose a position paper on infants' rights in wartime, as there is still a general lack of attention paid to the impact of war-related traumas on infants' development and psychological health. Though there are numerous areas of violent conflicts around the globe, there have been few published studies that relate specifically to infants. Consequently, humanitarian aid programs tend to overlook infants' psychological needs and to pay more attention to those of older children. This position paper first reviews the studies identified through a literature search, about the impact of war-related traumas during pregnancy and postnatal periods, then describes the existing recommendations that have been added to the Children Rights Convention and their implications for infant mental health clinicians.

Chronic trauma impairs the neural basis of empathy in mothers: Relations to parenting and children's empathic abilities

Early life stress carries long-term negative consequences for children's well-being and maturation of the social brain. Here, we utilize a unique cohort to test its effects on mothers' social brain, targeting mothers' neural empathic response in relation to caregiving and child empathic abilities. Mother-child dyads living in a zone of repeated war-related trauma were followed from early childhood and mother-child behavioral synchrony was repeatedly observed. At pre-adolescence(11-13 years) children's empathic abilities were assessed and mothers(N = 88, N = 44 war-exposed) underwent magnetoencephalography(MEG) while exposed to vicarious pain. All mothers showed alpha suppression in sensorimotor regions, indicating automatic response to others' pain. However, trauma-exposed mothers did not exhibit gamma oscillations in viceromotor cortex, a neural marker of mature empathy which utilizes interoceptive mechanisms for higher-order understanding and does not emerge before adulthood. Mother-child synchrony across the first decade predicted mothers' viceromotor gamma, and both synchrony and maternal viceromotor gamma mediated the relations between war-exposure and child empathic abilities, possibly charting a cross-generational pathway from mothers' mature neural empathy to children's empathic capacities. Our findings are first to probe the maternal social brain in adolescence in relation to parenting and underscore the need for targeted interventions to mothers raising children in contexts of chronic stress.

Young Children's Physiological Reactivity during Memory Recall: Associations with Posttraumatic Stress and Parent Physiological Synchrony

Autonomic reactivity is implicated in stress response and social engagement - both key components of posttraumatic stress disorder (PTSD) - but few studies have examined autonomic reactivity in pediatric samples, and no known studies have examined physiological synchrony among children with PTSD and caregivers. In a sample of 247 young children (94 girls, 153 boys), most (85%) of whom had exposure to trauma and 40% who met criteria for PTSD, we examined children's patterns of respiratory sinus arrhythmia (RSA) at baseline and in response to a memory recall task, as well as correspondence between parents' and children's RSA. Children with PTSD demonstrated significantly higher reactivity than other groups during their recollection of a traumatic memory, but not during other memory tasks. Regarding synchrony, caregivers' and children's RSA were more significantly and positively correlated during the trauma recall task among children who had had exposure to a potentially traumatic event but did not meet PTSD criteria, suggesting physiological synchrony may be protective in contexts of trauma. Overall, findings demonstrate physiological reactivity differences among young children with PTSD. While more work is needed to understand the meaning of parent-child physiological synchrony, these data suggest that children's psychopathology is associated with physiological synchrony processes among young children with exposure to trauma.

Caregivers' emotional competence and behavioral responsiveness as correlates of early childcare workers' relationships with children in their care

In the current study, we examined associations among early childcare workers' emotional competence, observed responsiveness, comfort with socioemotional teaching practices, and the quality of their relationships with children in their care. The participants were 100 early childcare workers (72 center-based Early Head Start teachers and 28 family childcare providers). Results showed that caregivers' emotion regulation ability was positively associated with caregiver-child relational closeness. Understanding and regulation of emotion were both positively associated with childcare workers' comfort with socioemotional teaching practices. Their observed responsiveness was positively related to relational closeness and negatively related to relational conflict. Findings are consistent with aspects of the prosocial classroom model, which asserts that educators high in emotional and social competence tend to adopt childcare practices that result in supportive relationships with children. Results provide insight into whether childcare workers' responsiveness to young children and their perceived socioemotional teaching practices provide a pathway between emotional competence and the quality of caregiver-child relationships.

Playing to live: outcome evaluation of a community-based psychosocial expressive arts program for children during the Liberian Ebola epidemic

BACKGROUND

This paper reviews the efficacy of a community psychosocial arts program focused on building mental health capacity within post-Ebola Liberia. The aim of this paper was to evaluate the outcome effects of two groups using pre- and post-treatment data. We hypothesized that there would be a difference in symptoms pre- and post-treatment, and the longer program would yield more significant results.

METHODS

There was a total of 870 child participants. Of 40 sites, 24 were selected for a 5-month treatment (TG1) while the remaining 16 sites received 3 months of treatment (TG2). Paired t tests and a mixed-model analysis of variance (ANOVA) were used to analyse pre- and post-psychological stress symptoms (PSS) for samples from both groups.

RESULTS

Separately, treatment group 1 (TG1) and treatment group 2's (TG2) paired t test yielded significant results (p < 0.001) for the decrease of PSS. The mixed-model ANOVA found that there were significant differences in total pre- and post-test PSS and a significant difference in PSS means over time.

CONCLUSIONS

Results indicated that there was a statistically significant decrease in reported symptoms in both treatment groups pre- to post-intervention and a significant difference in total symptoms over time. However, the findings do not indicate that the longer programming was statistically different compared to the shorter programming. The study presented had gaps in data, largely due to limits in research during the crisis. However, this paper provides a unique case study for challenges that can be faced for project evaluation in emergency settings.

Mothers and Toddlers Exposed to Political Violence: Severity of Exposure, Emotional Availability, Parenting Stress, and Toddlers' Behavior Problems

This study examined the potential risks of maternal and child exposure to traumatic events resulting from political violence, specifically those related to emotional availability, parenting stress and children's behavioral problems. It also evaluated the feasibility of mitigating these effects through a play-based group intervention for conjoint dyads of mothers and toddlers. Results from 54 dyads show that the higher maternal and especially child exposure to political violence and other trauma, the lower their emotional availability in dyadic interactions (r = .40, p < .01). Emotional availability was associated with the mother's parenting stress, and both parenting stress and emotional availability were associated with the mother's perceptions of her child's behavior problems. Comparisons of observed emotional availability, child behavior problems as perceived by the mother, and reported stress in 28 dyads before and after participating in the intervention suggest that it may be possible to bolster emotional availability and to reduce child's behavior problems.

The Neural Basis of Empathy and Empathic Behavior in the Context of Chronic Trauma

Background: Accumulating evidence in social neuroscience suggests that mature human empathy relies on the integration of two types of processes: a lower-order process mainly tapping into automatic and sensory mechanisms and a higher-order process involving affect and cognition and modulated by top-down control. Studies have also indicated that neural measures of empathy often correlate with behavioral measures of empathy. Yet, little is known on the effects of chronic trauma on the neural and behavioral indices of empathy and the associations among them. Methods: Mothers exposed to chronic war-related trauma and nonexposed controls (N = 88, N = 41 war-exposed) underwent magnetoencephalography (MEG) while watching stimuli depicting vicarious emotional distress. Maternal empathic behavior was assessed during mother-child interaction involving a joint task. Results: Empathy-evoking vignettes elicited response in alpha rhythms in a network involving both sensorimotor and viceromotor (anterior insula) regions, suggesting integration of the sensory and affective components of empathy. Whereas exposure to chronic stress did not affect the level of neural activations in this network, it reduced maternal empathic behavior. Furthermore, trauma exposure impaired the coherence of brain and behavior; only among controls, but not among trauma-exposed mothers, the neural basis of empathy was predicted by maternal empathic behavior. Conclusions: Chronic stress takes a toll on the mother's empathic ability and indirectly impacts the neural basis of empathy by disrupting the coherence of brain and behavior.

Methodology of "14-7" Program: A Longitudinal Follow-Up Study of the Pediatric Population and Their Families Exposed to the Terrorist Attack of Nice on July 14th, 2016

Introduction: After a traumatic event, children and adolescents may present several clinical consequences, the most common being Post-Traumatic Stress Disorder (PTSD). Most children and adolescents with PTSD have comorbid disorders, such Attention Deficit Hyperactivity Disorder, depression, attachment and anxiety disorders, sleep disturbances and behavior problems. However, epidemiological studies on the development of PTSD and other psychiatric disorders in children and adolescents as a consequence of a terrorist attack and mass murder are lacking. Long-term follow-up of exposed children and adolescents will help identify risk and protective factors of developing psychiatric and psychological conditions after exposure to traumatic events or situations. The main objective of this article is to present the methodology of "14-7" program. The aim of "14-7" program is to characterize the risk and protective psychosocial factors affecting the clinical evolution of a pediatric population sample, exposed to the terrorist attack of July 14^th, 2016 in Nice. Method and Analysis: "14-7" program is a multicentre longitudinal cohort study. Major inclusion criteria are children and adolescents exposed to the terrorist attack and aged under 18 years on July 14^th, 2016. These children and adolescents will be compared to a non-exposed to the "14-7" terrorist attack group, matched on age and gender. Participants will be assessed at baseline (T1), 2 years (T2) and 5 years (T3) after the initial assessment (T1), and every 5 years until they are 25 years old. Multiple domains are assessed: 1) mental health disorders, 2) intensity of PTSD symptoms, 3) intensity of comorbid symptoms, 4) quality of the parent-child relationship, 5) intelligence quotient, 6) parental symptoms. We will also establish a biological collection of saliva samples, magnetic resonance imaging (MRI) and actigraphy data collection. Main analyses comprise analyses of variance and regression analyses of predictors of clinical evolution over time. Ethics and Dissemination: The National Ethics Committee "NORD OUEST III" approved the "14-7" Program protocol (number 2017-A02212-51). All patients and their caregivers signed informed consent on enrolment in the "14-7" Program. Inclusions started on November 21^st, 2017. Three hundred thirty-five individuals have been included (191 children and adolescents, 144 parents). Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03356028.

Adverse impact of multiple separations or loss of primary caregivers on young children

Background: Young children may be adversely impacted by separation from and loss of caregivers and other loved ones. Such experiences often co-occur with interpersonal violence, unpredictability and other traumas. Whether separation/loss has unique effects independent of those other adversities is not known. Objective: This study aimed to establish whether separation/loss is associated with trauma-related symptoms, psychiatric disorders, and functional impairment in 18- to 48-month-old children independent of other adversities. Methods: Data from a cross-sectional community and clinical cohort were analyzed. Recruitment occurred in pediatric primary care, mental health, and developmental services sites. Children (33% female) were heterogeneous in ethnic background (55% minority) and family socioeconomic status (40% living in poverty). Results: Separation/loss was common (30.9% single type, 15.0% multiple types) and frequent amongst violence-exposed children (84.4% of violence-exposed children had experienced separation/loss from a loved one). However, violence exposure was uncommon amongst children with separation/loss experiences (only 23.9% were violence-exposed). Separation/loss was significantly associated with symptoms of posttraumatic stress and reactive attachment, as well as impairment and psychiatric disorders in models that controlled for sociodemographic and contextual risks, including other traumas. Psychiatric disorders were approximately 2.5 times more likely in children who had experienced multiple separations/losses, after accounting for interpersonal violence which was also significant. Conclusion: Professionals working with young children, policy-makers and caregivers should be aware that an accumulation of caregiver separations/losses, irrespective of violence and other traumatic exposure, may have detrimental effects on young children especially in the context of prior separations/losses or disruptions in their lives.

Stress and immune biomarkers interact with parenting behavior to shape anxiety symptoms in trauma-exposed youth

The relations between stress, HPA-axis, and the immune system have been extensively studied; however, no study to date addressed the joint contribution of immune and HPA biomarkers to the development of anxiety in youth exposed to chronic trauma as mediated by mother-child interaction patterns. A unique cohort of war-exposed children and their mothers, compared to matched controls, were followed from infancy and the current study reports findings from early adolescence (mean age = 11.66, SD = 1.23; N = 111; exposed = 58 control = 53). Youth and mothers' salivary cortisol (CT) and secretory immunoglobulin (s-IgA) levels were measured three times during a 4-hour lab visit, mother-child interaction patterns were quantified from a joint task, and children's anxiety symptoms diagnosed. Trauma-exposed children had higher levels of CT and s-IgA, exhibited more anxiety symptoms, and showed lower social collaboration with mother during the joint task. Trauma-exposed mothers had higher CT and s-IgA levels and showed less supportive parenting during mother-child interaction. Structural equation modeling defined three bio-behavioral paths by which trauma increases anxiety in youth. While the first path charted a behavioral link from exposure to child anxiety via diminished maternal support, the other two paths described mediated biological paths, one through HPA-axis functioning, the other via the immune system. Paths via the child's HPA and immune system were mediated by the parallel maternal variable. Findings are the first to describe the complex bio-behavioral interplay of stress and immune biomarkers and parenting behavior in shaping to the development of risk and resilience trajectories in youth growing up amidst chronic trauma.

Chronic Early Stress Impairs Default Mode Network Connectivity in Preadolescents and Their Mothers

BACKGROUND

Early life stress (ELS) bears long-term negative consequences throughout life. Yet ELS effect is mostly unknown, and no study has followed children to test its impact on the default mode network (DMN) in relation to maternal behavior across childhood. Focusing on brain oscillations, we utilized a unique cohort of war-exposed preadolescent children (11-13 years of age) and their mothers followed from early childhood to examine the effects of ELS combined with observed parenting on DMN connectivity and power in mother and child.

METHODS

Participants included 161 mothers and children (children: 39 exposed/36 control subjects; mothers: 44 exposed/42 control subjects) who underwent magnetoencephalography scanning during rest.

RESULTS

Stress exposure reduced DMN connectivity in mother and child; however, in mothers, the impaired connectivity occurred in the alpha band, whereas among children it occurred in the theta band, a biomarker of the developing brain. Maternal anxiety, depression, and posttraumatic symptoms in early childhood predicted lower maternal DMN connectivity. Among children, the experience of intrusive, anxious, and uncontained parenting across the first decade and greater cortisol production in late childhood predicted reduced DMN connectivity in preadolescence. Impairments to theta DMN connectivity increased in children with posttraumatic stress disorder.

CONCLUSIONS

Findings indicate that ELS disrupts the synchronous coordination of distinct brain areas into coherent functioning of the DMN network, a core network implicated in self-relevant processes. Results suggest that one pathway for the lifelong effects of ELS on psychopathology and physical illness relate to impaired coherence of the DMN and its role in maintaining quiescence, alternating internal and external attention, and supporting the sense of self.

PTSD in Children Below the Age of 6 Years

PURPOSE OF REVIEW

This review summarizes the latest evidence and developments in the validation of PTSD diagnostic criteria for children 6 years and under (PTSD<6Y), discusses the limitations of the current diagnostic criteria, and highlights areas for future research.

RECENT FINDINGS

Research has found that the DSM-5 PTSD<6Y, and a similar version in the DC:0-5, currently provides the most developmentally sensitive classification of PTSD for young children. In contrast, preliminary evidence suggests that the ICD-11 criteria might not appropriately capture PTSD in young children. The inclusion of PTSD<6Y, the first developmental subtype in the DSM-5, represents an important step towards having a diagnostic system that is developmentally sensitive and relevant across the life span. However, further validation work and research with regard to the definition of trauma and functional impairment as well as with the age-appropriate description of symptoms is needed, especially in the youngest age group (0-3 years).

Attachment as a Core Feature of Resilience: A Systematic Review and Meta-Analysis

Background

Research has pointed to secure attachment as a possible key factor of resilience in adulthood.

Objective

We aimed to investigate the role of secure attachment as a potential core feature in the properties of resilience.

Methods

We conducted a systematic review in accordance with PRISMA guidelines followed by a meta-analysis.

Results

Thirty-three studies were included in the review, and 10 of these, including 2305 subjects, were used for meta-analysis. The raw correlation coefficients ranged from .20 to .57, which indicated weak to moderate correlations between resilience and attachment. The synthesized correlation coefficients indicated that the correlations were significant and highly unlikely to be due to random variation. All studies are also reported on qualitatively.

Conclusions

In both of our meta-analyses and in the narratively reported studies, we found that secure attachment is associated with the presence of resilience.

Cognitive-Behavioral Treatment of PTSD With a Young Boy and His Mother Following the Experience of Chronic Domestic Violence

This case study follows a 7-year-old boy who presented with symptoms of posttraumatic stress disorder (PTSD) following exposure to domestic violence beginning at a very young age. During evaluation of this young boy’s symptoms, it became evident that his mother also was experiencing symptoms of PTSD. Consequently, treatment for both this young boy and his mother was proposed. Cognitive-behavioral therapy (CBT) has been used widely with both children and adults to treat PTSD. Fortunately, treatments have been tailored for young children (e.g., trauma-focused CBT [TF-CBT]; preschool PTSD treatment [PPT]) and for adults (e.g., cognitive processing therapy [CPT]). In the current case study, a combination of PPT and TF-CBT was utilized to treat this young boy, and CPT was utilized to treat his mother. With this course of treatment, this young boy demonstrated decreases in his PTSD symptoms and gained an understanding of coping skills and cognitive restructuring. His mother also demonstrated decreases in her PTSD symptoms. Overall, this dyad showed qualitative improvements in their general emotional and behavioral functioning, their individual self-regulation abilities, their social interactions, and their relationship. This case study provides evidence for the importance of treating both young child and parent when both have been exposed to and traumatized by domestic violence. Furthermore, this case study provides a framework for other health service providers to implement conjoint treatment of similarly traumatized families.

The Function of Play for Coping and Therapy with Children Exposed to Disasters and Political Violence

PURPOSE OF REVIEW

The objectives were to identify specific characteristics and patterns of children's play following events of political violence or disasters, examine their associations with risk and resilience, and explore their implications for preventive and therapeutic intervention.

RECENT FINDINGS

Patterns of individual, dyadic, and social play are associated with measures of children's adaptation following collective traumatic events. Modifying the traditional child-centered play therapy, by integrating CBT principles or including parents, may increase efficacy. Preventive interventions in the aftermath of collective traumatic events must address children's need to play in safe spaces, with the support of significant adults. Recognizing that posttraumatic play is a multifaceted phenomenon implies the need for more individualized play therapy models, varying in level of therapist's activity and techniques employed. Research is needed to clarify the validity of play measures for assessing adaptation and to study the effectiveness of integrative play-based models.

Maternal immune and affiliative biomarkers and sensitive parenting mediate the effects of chronic early trauma on child anxiety

BACKGROUND

Chronic early trauma alters children's stress reactivity and increases the prevalence of anxiety disorders; yet the neuroendocrine and immune mechanisms underpinning this effect are not fully clear. Animal studies indicate that the mother's physiology and behavior mediate offspring stress in a system-specific manner, but few studies tested this external-regulatory maternal role in human children exposed to chronic stress.

METHODS

We followed a unique cohort of children exposed to continuous wartime trauma (N = 177; exposed; N = 101, controls; N = 76). At 10 years, maternal and child's salivary immunoglobulin A (s-IgA) and oxytocin (OT), biomarkers of the immune and affiliation systems, were assayed, maternal and child relational behaviors observed, mother and child underwent psychiatric diagnosis, and child anxiety symptoms assessed.

RESULTS

War-exposed mothers had higher s-IgA, lower OT, more anxiety symptoms, and their parenting was characterized by reduced sensitivity. Exposed children showed higher s-IgA, more anxiety disorders and post traumatic stress disorder, and more anxiety symptoms. Path analysis model defined three pathways by which maternal physiology and behavior impacted child anxiety; (a) increasing maternal s-IgA, which led to increased child s-IgA, augmenting child anxiety; (b) reducing maternal OT, which linked with diminished child OT and social repertoire; and (c) increasing maternal anxiety, which directly impacted child anxiety.

CONCLUSIONS

Our findings, the first to measure immune and affiliation biomarkers in mothers and children, detail their unique and joint effects on children's anxiety in response to stress; highlight the relations between chronic stress, immune activation, and anxiety in children; and describe how processes of biobehavioral synchrony shape children's long-term adaptation.

Psychosocial symptoms in very young children assessed for sexual abuse: A qualitative analysis from the ASAC study

Child sexual abuse (CSA) is a worldwide problem with serious consequences. No recognizable symptom pattern for suspected CSA has yet been identified in very young children. We aim to investigate psychosocial symptoms in a sample of children with confirmed or strongly suspected CSA and the interpretations given to such symptoms by independent clinical experts. Secondly we examined whether experts were able to identify confirmed victims of severe CSA. A qualitative study including inductive content analysis of medical files and focus group discussions with independent experts on the interpretation of psychosocial symptoms was conducted. We included 125 children (76 boys, 60.8%, and 49 girls, 39.2%; median age 3.3 years; age range 0-11) who were involved in the Amsterdam sexual abuse case (ASAC) and had been examined for strongly suspected CSA. We identified four themes among the psychosocial symptoms: problems concerning emotions, behavior, toilet training, and development, whether or not associated with the daycare center or the perpetrator. Clinical experts identified signs of posttraumatic stress disorder (PTSD), regression in continence skills (not otherwise explained), and problems triggered by exposure to the perpetrator or the abuse location as concerning symptoms for CSA. Less concerning symptoms were designated as worrisome if they were numerous and there was no clear explanation for these symptoms. A clear symptom pattern was lacking and about half of the confirmed severe victims of CSA did not display any psychosocial problems. Therefore, it is difficult for experts to identify confirmed CSA victims. Thus, the assessment of suspected CSA should be over time and multidisciplinary.

Pre-Conception War Exposure and Mother and Child Adjustment 4 Years Later

Evidence is accumulating for the transgenerational effects of maternal stress on offspring. A particular increasing concern is the possible transgenerational effects of community exposure to war and terror. Here, 107 mothers that had been exposed to war, were assessed with their 3 year old children (52 % girls) who had been conceived after the end of the war, and thus never directly exposed to war. The circumscribed nature (missile bombardment) and temporal limits (34 days) of the tragic 2006 Lebanon war in the north of Israel, affords a unique methodological opportunity to isolate an epoch of stress from preceding and subsequent normal life. We find that war experience engenders higher levels of mothers' separation anxiety, lower emotional availability in mother-child interaction, and lower levels of children's adaptive behavior. The novelty of these findings lies in documenting the nature and strength of transgenerational effects of war-related stress on offspring that were never exposed. In addition, because these effects were obtained after 4 years of a continuing period of normality, in which the children were born and raised, it suggests that an extended period of normality does not obliterate the effects of the war on mother and child behavior as assessed herein. Despite the study limitations, the results are indicative of persisting transgenerational effects of stress.

Life satisfaction and trauma in clinical and non-clinical children living in a war-torn environment: A discriminant analysis

The aim of this work was to discriminate between healthy children and children at risk of developing mental impairments by evaluating the impact on contextual and individual factors of a context characterized by war. We tested the hypothesis that a linear discriminant function composed of trauma, life satisfaction, and affect balance has the power to classify the children as community or clinical referred. Membership of the clinical-referred group was associated with poorer life satisfaction and higher levels of trauma. Community-referred profiles were associated with lesser trauma. Perceived life satisfaction regarding family and school was the main contributor to the discriminant function.