Children of Chowchilla: a study of psychic trauma.
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The authors assessed war violence exposure and behavioral symptoms in Bosnian refugee children in Massachusetts and the utility of behavioral screening of refugees during the Refugee Health Assessment (RHA), required of newly arrived refugees. The study was a survey of 31 Bosnian refugee children in 1996 at the International Clinic of Boston Medical Center, the state's largest contracted provider of the RHA. Subjects were also offered referrals to appropriate mental health services. Sixty-eight percent experienced long-term separation from a parent. Eighty-one percent were directly exposed to armed combat. Seventy-one percent experienced the death of a close friend or relative. Fifty-two percent experienced economic deprivation. Families reported behavioral symptoms for 77% of children. Only one family expressed interest in psychosocial services of any kind. Large numbers of Bosnian refugees are likely to have experienced traumatic war violence and are at risk of behavioral symptoms. The RHA affords opportunities to screen for behavioral problems but not to intervene. Primary care providers and other clinicians should be aware of likely recurrences of symptoms in high-risk children such as these.
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Behavioural changes in 85 two-to-ten-year-old children were evaluated by the parents one day, one week and one month after a routine ENT operation. Twenty (23%) children showed no changes. Behavioural problems at least once during the observation time were seen in 52 (61%) and improvements in 28 (33%) children, 15 (17%) had both. There was no statistically significant difference between the children treated as day cases and those hospitalized for one or two nights, or between the girls and the boys. The proportion of children showing behavioural problems decreased from 59% at 1 day to 32% at 1 month after the operation. The highest incidence of problematic changes occurred in children aged 3, 5 years or younger (79%), and the incidence was lowest in the 5.0-6.9-year-olds (43%). The most common changes were an increase in seeking attention from the parents (in 34% of the children), temper tantrums (25%), waking up at nights (16%) and problems in eating (16%).
The unique relations of effortful control and impulsivity to resiliency and adjustment were examined when children were 4.5 to 8 years old, and 2 years later. Parents and teachers reported on all constructs and children's attentional persistence was observed. In concurrent structural equation models, effortful control and impulsivity uniquely and directly predicted resiliency and externalizing problems and indirectly predicted internalizing problems (through resiliency). Teacher-reported anger moderated the relations of effortful control and impulsivity to externalizing problems. In the longitudinal model, all relations held at T2 except for the path from impulsivity to externalizing problems. Evidence of bidirectional effects also was obtained. The results indicate that effortful control and impulsivity are distinct constructs with some unique prediction of resiliency and adjustment.
This prospective study investigated the role that life events play in causing emotional and behavioural problems in a population of 240 primary school children who had recently survived a natural disaster. Life events experienced after the disaster were not found to contribute directly to the number of emotional or behavioural problems when the effect of the disaster was taken into account. This suggested that, in children, life events may not have a simple mechanically additive aetiological effect.
Mothers in the last trimester of the second pregnancy admit to being less active, more tired and moody than previously. Many were more anxious than usual. Their first child frequently showed behavioural changes. Those surveyed were between 1 1/2 and 4 years of age and showed more clinging, sleep disturbance and misbehaviour with tantrums than expected. It is presumed that the mother's pregnancy induces anxiety in her child with consequent behavioural changes.
Childhood behavioral problems are found to be related to both early temperament and parental behavior, in that first-year temperament scores predicted mild (but not more severe) problems. A parental pathology scale discriminated more severe cases among girls only; more severe cases among boys were accompanied by negative temperament changes. For both sexes, the form of subsequent behavioral problems was associated with first-year temperament patterns.
Certain parents use their child as a representative of their own unacceptable impulses, perceiving the youngster as evil and seeking experts to confirm their opinion. They come to mental health clinics for diagnoses but not treatment; evidence that contradicts their view is ignored out of a need to protect their own precarious psychological balance. The child, in spite of good early adjustment, tends to conform to the parents' preferred perception. Legal and ethical implications for professionals working with such cases are discussed.
Children often respond to hospitalization with severe anxiety and depression, frequently manifested by withdrawal or hyperactive and aggressive or hostile behavior. The use of paraverbal therapy, a specialized therapeutic approach, is described in the short-term treatment of patients exhibiting emotional disturbances secondary to illness or trauma.
Increasing survival rates for children with cancer raise questions about the long-term psychosocial impact of the disease and its treatment. Psychiatric evaluations of 114 survivors of childhood malignancies suggest a high rate of adjustment problems, with 59% indicating at least mild psychiatric symptomology. Interviews with former patients highlight the importance of adaptive denial in the face of the uncertainty connected with cancer survival.
This study examines the impact of exposure to family violence on school-aged boys. Boys who had witnessed violence between their parents were compared to boys who had been abused by their parents. The findings indicate that boys exposed to violence had a pattern of adjustment problems similar to those of abused boys and significantly different in severity and type from those of a community comparison group.
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The author describes characteristics of patients, primarily adolescents, who suffer from episodic violent behavior and their relations with their families. Typical family patterns include overly close alliances by the adolescent with one or both parents and transmission by parents of inconsistent values regarding aggression. Family therapy is the preferred treatment approach; treatment should be active, should initially focus on ways of handling dyscontrol episodes, and should emphasize that the patient is responsible for his or her actions.
Classically, incest has been considered from both a psychological and sociological point of view to have harmful consequences. Genetic research, though by no means lacking controversy of its own, generally supports the notion that inbreeding has untoward genetic consequences. The psychodynamics of all three parties to father-daughter incest seem to indicate that people who become involved in incestuous behaviour are often psychologically damaged before the fact, so that if they show subsequent evidence of psychological impairment the incestuous behaviour can be as plausibly viewed as a dysfunctional attempt at solving problems as it can a cause of subsequent psychopathology. Girls involved in the father-daughter incest present in one of half a dozen frequent clinical syndromes. The presentation is influenced by the degree to which the girl may have participated in ongoing incestuous behaviour as opposed to being the presumed victim of an older adult's coercive actions or her own temporary suspension of a behavioural taboo. Research is inconclusive as to the psychological harmfulness of incestuous behaviour, and evidence is reviewed on both sides of this complicated and controversial question. Quite apart from the general issue of the harmfulness of incest, a number of indicators can be derived from the nature of the incestuous episode and the early response to therapeutic assessment which aid in the clinical forecasting of probable outcome.
A group of child psychoanalysts, associated with the Cleveland Center for Research in Child Development and the Hanna Perkins Therapeutic Nursery School and Kindergarten, studied 23 children who had lost a parent through death. These children varied greatly in socio-economic, religious, racial and ethnic background and had suffered bereavement at different points in their development, as early as a few weeks old and as late as 13 years of age. The majority were in individual psychoanalytic treatment, seen 5 times weekly over several years. Some were treated by way of the parent while attending the Hanna Perkins Therapeutic School. The research group compared and discussed the multitude of data with a view to understanding mourning and the effects of bereavement on the personality, with a view to developing techniques in assisting children and families cope with the stress, and with a view to developing some prophylactic measures to minimize pathological resolutions. The results of the research were published in "A Child's Parent Dies" (1). This paper focuses on sharing those findings which might be helpful to the clinician in the assessment of bereaved patients and in assisting them and their families in the crucial period of parental loss or shortly following it.
A clinical study of nine children between the ages of 4 and 15, who had undergone arm or leg amputation is presented. The emotional reactions of all those involved - the child, family, and the treatment team - are described. Amputation creates extreme stress in all participants in the procedure. Some similarities were found in the defensive mechanisms and stages experienced by the child, the family and the members of the treatment team.