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Friday, September 12, 2008

Military Kids Also Serve, Feel Stress and Strain of Nation's Wars

Did you know that about 700,000 American children have had at least one parent deployed in the Middle East since our invasion of Afghanistan? Today, over 155,000 kids have a deployed parent overseas supporting our operations in Afghanistan and Iraq.

While a resilient bunch, a lot of worry and strain are being carried on their little shoulders. Are they getting all the support they need?

Back in May, I spoke at a "Healing the Hidden Wounds" summit organized by National Public Television and NAMI-TN. Among the stream of amazing speakers drawn together that day was a 24-year military wife and mom (and active professional social worker with Ft. Campbell's Family Readiness Group and the Centerstone Community Mental Health Centers).

Susan Pease's words were among the more poignant of the day. She tried to answer the question, "What do military families need?" From my notes, here were a few of her responses:

  • Military kids are desperately in need of resources and supports. Their needs appear to be among the most overlooked of all aspects of of our nation's protracted wartime stance. While Military Family Life Consultants, Military OneSource and MilitaryHOMEFRONT are wonderful resources, more are needed.

  • Military children are acting out and need more peer group programs. Some are stealing prescription drugs from parents, coping with abandonment issues and angry that their deployed parents have missed so many important days (like graduation, etc.) over the years. These are signs that more substantial peer group programs are needed to help cushion their experience. Parents can't do it all.

  • Parents are also under stress and need more child care tools. Left behind on their own -- as strong and capable as they are -- they are starved for supports and tools to help their kids to cope with the many emotions they feel before, during and after deployment. Parents need more adolescent care help, and parenting help, and activities that will bring kids together and foster ways for them to be able to talk their feelings and anger and worries out with each other.

In educational interest, article(s) quoted from extensively.

Last year, the Milwaukee Journal Sentinel's Rachel Rutledge examined the issue and drew the same conclusion:

Paralleling their parents' fight against stealthy insurgents, children at home battle enemies they can't see and often don't understand. From bed-wetting and high blood pressure to depression and isolation, the wars invade their young lives in ways that experts say are potentially damaging mentally and physically. These ways go beyond disappointment, deeper than just missing Mommy or Daddy.

As countless reports emerge about the lack of proper care for the troops, civilian and military specialists agree, not nearly enough is being done to protect their children.

A preliminary report released last year by the American Psychological Association [pdf], "The Psychological Needs of U.S. Service Members and Their Families," brings together the prevailing research:

The Impact of Military Deployment on Children and Adolescents

Military service is a reciprocal partnership between the Department of Defense, service members and their families (Department of Defense, 2002). The military culture has evolved considerably from the World War II mindset characterized by the popular slogan, if the Army wanted you to have a family, they would have issued you one! Leaders now recognize that supporting families and children is key to the readiness and retention of service members, and there is widespread acknowledgment that, in their own way, families also serve.

In 2002, the DoD published the following statement: A Social Compact promotes the advancement of the military community through the reciprocal ties that bind service members, the military mission, and families by responding to the quality of life needs. This document specifically states that one of the Quality of Life areas of particular importance is support during the deployment cycle (DoD, 2002, p.60).

The active duty force (1.4 million) is outnumbered by the associated dependent family members (1.8 million). Among these family members, 1.2 million are children and adolescents (up to age 23). The Reserve and National Guard forces number nearly 900,000 with over 700,000 dependent children (Military Family Research Institute, 2004). At any one time, over half a million children have one or more parents deployed in support of the GWOT. Clearly, the number of children who have been affected by reoccurring deployments is significant.

Before specifically addressing the consequences of deployment, the unique constellation of stressors on military children must first be acknowledged. It is generally agreed that geographic mobility (multiple moves) and isolation, frequent separations, and the normative constraints of the military culture impact children in military families (Drummet et al., 2003; Ender, 2000, 2006; Finkel et al., 2003; Segal, 2006; Watanabe & Jensen, 2000). The repeated and extended separations and increased hazards of deployment (i.e., injury and death) compound these stressors in military children's lives. However, despite these significant stressors, levels of psychopathology in military children have been found to be at or below those in the civilian population (Jensen et al., 1991; 1995), thus attesting to their resilience.

It should be recognized that children's responses to deployment are variable and depend on age and developmental stage, in addition to family and individual factors (Amen et al., 1988; Murray, 2002; Pincus et al., 2005; Stafford & Grady, 2003). In the pre-deployment phase infants have been observed to be fussy and change their eating habits. Preschoolers can be confused and saddened by pending changes in the family. School-aged children will also be saddened, but may also become angry and experience anxiety. In addition to these mood states, adolescents may withdraw and deny feelings about the upcoming separation.

In the deployment phase, preschoolers may display sadness, tantrums, changes in eating and elimination habits, and separation anxiety in regard to the remaining caretaker. School-aged children may experience more somatic complaints, changes in mood, and a decline in school performance. Adolescents may be angry, aloof, and apathetic; they may act out more or lose interest in their usual activities and experience school problems. Others may embrace the new independence and try to assume the role of the missing parent (Amen et al., 1988; Blount et al., 1992; Pincus et al., 2001; Stafford & Grady, 2003).

The post-deployment phase can lead to powerfully ambivalent emotions in both children and adolescents. High expectations and behavior changes in the returning service member contribute to the challenges of readjustment. Very young children may not recognize the service member and may be afraid of him or her. Preschoolers, while happy and excited, may also display anger about the separation. Likewise, school-aged children may be simultaneously excited and angry.

They may act out their anger or may require unsustainable levels of attention. Adolescents may be defiant and disappointed by the difficulty the service member has acknowledging the changes the adolescent made in his or her absence (Amen et al., 1988; Blount et al., 1992; Pincus et al., 2001; Stafford & Grady, 2003). The responses by children to deployment are summarized in Table 1.

Table 1. Deployment Stages and Children's Responses

(Amen et al., 1988; Murray, 2002; Pincus et al., 2001; Stafford & Grady, 2003)

  • Infants: Fussy, changes in eating habits
  • Preschoolers : Confused, saddened
  • School-Aged: Saddened, angry or anxious
  • Adolescents: Withdrawn, deny feelings about pending separation

  • Infants: No research
  • Preschoolers: Sadness, tantrums, changes in eating/elimination habits, symptoms of separation anxiety may appear
  • School-Aged: Increased somatic complaints, mood changes, decline in school performance
  • Adolescents: Angry, aloof, apathetic, acting out behaviors may increase, loss of interest in normal activities, decline in school performance

  • Infants: May not recognize returning service member and be fearful of him/her
  • Preschoolers: Happy and excited, but also experience anger at separation
  • School-Aged: Happy and angry, often leading to acting out behaviors
  • Adolescents: Defiant, disappointed if their contributions at home are not acknowledged

Adolescents' adaptation to their parents' deployment has been recently studied by Huebner and Mancini (2005). Participants reported depression and changes in school performance, as well as an awareness of the dangers associated with parents' deployments. The study also found that adolescents tried to protect those remaining at home from stress and negative emotions and were wary of media coverage of the war. The authors concluded that deployment often has detrimental effects on adolescents' lives, and that these stressors may overtax the adolescents'
limited coping resources beyond their capacity (p. 11). While some adolescents seek social support during a parent‘s deployment, others become socially isolated. ...

Across various studies, depression, anxiety, and internalizing disorders have been found to be related to deployment (Jensen et al., 1989, 1996; Hillenbrand, 1976; Huebner & Mancini, 2005; Kelley et al., 2001). Boys seem to suffer more effects than girls (Jensen et al., 1996), and younger children overall are more susceptible to the effects of longer deployments. Older studies also suggest that academic grades can be negatively affected (Hillenbrand, 1976; Yeatman, 1981).

Again, from the Journal Sentinel:

The war threatens the psychological well-being of soldiers, spouses and their children so much that the urgency with which the issue should be addressed "cannot be overstated," the [APA] task force [which created the above research paper] reported in February.

"It's heartbreaking," said Shannon Gallagher, a counselor at the camp in Hudson, in St. Croix County. Children from military families gathered there for a week in July as part of Operation Purple, a program offered by the National Military Family Association. ..."I have some 16-year-olds that are homesick, which is really uncommon," she said. "They feel compelled to be at home, helping their mom. . . Some have a fear that when they go home both parents might be gone." ...

Ian, a thoughtful, talkative boy from Stevens Point, expressed stress from his dad's deployment with anger, said his mom, Heidi O'Brien. He slammed doors and ordered his mom to call his dad and demand that he come home from Iraq "right now."

"It's not fair," he would tell her. "Why am I the only one without a dad?"

"He was mad at me that I let him go," she said. "He thought I should have stopped him." Ian's dad, Thomas O'Brien, a major in the National Guard, had been active in every aspect of Ian's life before he was called to active duty. He took Ian fishing, attended football and baseball games, concerts and all the events the children were involved in, Heidi O'Brien said.

"We truly missed his presence every single day," she said.

And it didn't help Ian that other kids didn't understand.

"One kid said to him, 'Your dad is in Iraq? He must get shot at every day,' " she said. Other parents and children report similar comments from their civilian peers. In group discussions at the camp, the kids ranked being made fun of and called names among the 10 worst things about being a soldier's child.

Fear that their parent would be injured topped the list. Added responsibilities, being separated from their parent and feeling unsafe also made the list, as did the realization that "your dad can come home very mean." The problems intensify the more often and the longer a parent is at war, experts say. ...

"The very large majority of Army families do a tremendous job of coping with stresses the rest of us can barely imagine," said Deborah Gibbs, lead author of a Pentagon study published last week in The Journal of the American Medical Association. "For small groups of families, the deployments are associated with substantial problems."

Another study, which appeared in the May 2007 issue of the Journal of Epidemiology had some disheartening statistics:

Rates of abuse and neglect of young children in military families in Texas has doubled since October 2002, a University of North Carolina at Chapel Hill study shows, raising concerns about the impact of deployment on military personnel and their families across the country.

The study, published in the May 15, 2007 issue of the American Journal of Epidemiology, was designed by UNC School of Public Health researchers to measure the impact of the 9/11 terrorist attacks on military and non-military families. The researchers chose to study Texas because of the large military population there and the availability of data.

Researchers found that prior to October 2002, rate of abuse and neglect – called maltreatment – was slightly higher among non-military families compared to military families. However, after the U.S. started sending larger numbers of troops to Afghanistan and Iraq in 2003, rates of abuse and neglect in military families far outpaced the rates among non-military families. Military files indicate more troops were deployed and fewer returned home in 2003.

In addition, the rate of occurrence of substantiated maltreatment in military families was twice as high in the period after October 2002 compared with the period prior to that date. During the same period, the rate of substantiated child abuse and neglect was relatively stable for non-military families, said Danielle Rentz, Ph.D., lead author of the study, which was part of her doctoral dissertation at the UNC School of Public Health.

“Among soldiers with at least one dependent, for every one percent increase in the number of active duty soldiers departing or returning, we saw an approximately 30 percent increase in the rate of substantiated maltreatment cases,” Rentz said. “These findings indicate to us that both departures to and returns from operational deployment impose stresses on military families and likely increase the rate of child maltreatment.”

State records showed that the majority of substantiated child abuse and neglect that occurred in military families was perpetrated by a parent, Rentz said. Before October 2002, the parent who was in the military was the perpetrator of abuse and neglect about equally as often as the non-military spouse. However, between October 2002 and June 2003, the non-military parent was found to have abused or neglected the children more often than the military parent.

“The stress of war extends beyond the soldier to the family left behind,” Rentz said.

Recently, the Kitsap Sun looked at one important program aimed at helping military kids bond with their peers and work through their experiences and emotions:

Military kids are ditching their deployment-related stress in the woods this week. At Island Lake Camp in Central Kitsap and Camp Seymour on the Key Peninsula, the grounds are full of teenagers who have a parent deployed, just back, or preparing to go. ...

"Camp is camp," [Kathleen Moakler of the National Military Family Association in Washington, D.C.] said, adding that having fun is the No. 1 priority, but that campers are also offered some tools to cope with deployment stress. ...

Moakler said that kids' common deployment worries are that something will happen to their parent, that the parent won't come back as the same person who left, or that they themselves will change. There are challenges of new roles and responsibilities, and disappointment when milestones can't be shared.

"This gives them tools to deal with it, to know other children are going through what they're going through, and that's half the battle," Moakler said.

Kaleigh Basso, who will be a freshman at Bremerton High in a couple of weeks, said the Operation Purple camp "is definitely cooler because the civilian kids don't really understand what we're going through."

Basso's father spent two months in San Diego with the aircraft carrier USS John C. Stennis. Her mom is a nurse at Naval Hospital Bremerton.

"It wasn't really a worry thing," she said of her dad being gone. "It was more just stressing out because I had to take on half of his jobs and half of my mom's jobs, and I still had to deal with school." ...

This year, there will be 100 weeks of Operation Purple camps held in 62 locations across the nation.

More information
An article in July 2008's Journal of Clinical Psychology, "Psychological adjustment and treatment of children and families with parents deployed in military combat," offered its readers a "series of case vignettes [to] illustrate the psychological adjustment and treatment implications for children with parents deployed in support of military combat operations." Very informative.

In May, ABC News' Bob Woodruff filed a related video report.

And finally, loads -- and I mean, loads -- of important resources at the American Academy of Pediatrics "Support for Military Children & Adolescents" website, which has info sheets, videos and more all devoted to helping military families.

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