Young children's behaviour linked to parent deployment

Behavioural problems in very young children linked to parential wartime development

Marlene Busko

Medscape Medical News 2008. © 2008 Medscape

November 7, 2008 — Very young children (3 to 5 years old) with a parent deployed to a war zone exhibit more behavioural symptoms than their peers without deployed parents, even after any stress or depression in the non deployed parent was controlled for, new research suggests.

"This study is a wake-up call, in that it is easier to spot symptoms in school-aged children and think that younger children may be less affected," lead author Molinda M. Chartrand, MD, from Boston University School of Medicine, in Massachusetts, told Medscape Psychiatry.

"Clinicians need to be aware that young children from military families may present with behaviour problems related to their parents' deployment," she said.

Most often, the behaviour is expressed as externalizing symptoms, such as aggression or attention difficulties, but the children may have internalizing symptoms, such as eating disturbances, anxiousness and depression, somatic complaints, and withdrawal, which can be harder to detect.

The study, the first to demonstrate the effect of current wartime deployment on behaviour in very young children, was published in the November issue of the Archives of Pediatric & Adolescent Medicine.

More than 2 Million Children Affected

Although more than 2 million American children — 40% younger than 5 years — have had a parent deployed to Iraq or Afghanistan, little research has focused on the effects of parental deployment on the very young.

A previous study showed that school-aged children with parents deployed in Operation Desert Storm had increased behavioural symptoms. Current deployment to Afghanistan or Iraq lasts between 12 and 15 months, which is longer than Operation Desert Storm and represents a significant portion of a young child's life.

To assess the effect of parental deployment on the behaviour of very young children, the researchers surveyed both parents and childcare providers of children 18 months to 5 years old who were enrolled in an on-base military childcare centre from May to December 2007.

One in 5 Children Showed Clinically Significant Symptoms

A total of 55 children with a deployed parent and 114 children without a deployed parent were included in the study.

In 92% of the parental deployments, it was the child's father who was deployed. At the time of the study, the parents had been deployed for an average of only 3.9 months.

For each child, parents completed the Child Behaviour Checklist (CBCL) survey and the child's caregiver completed the Child Behaviour Checklist Teacher Report Form (CBCL-TRF) to assess externalizing and internalizing behaviour symptoms. The sample was stratified by age into 2 groups: younger than 3 years and 3 to 5 years.

Children 3 to 5 years with a deployed parent (n = 31) had significantly higher externalizing and total-symptom scores than their peers without a deployed parent (n = 65).

Among the 31 children 3 to 5 years with a deployed parent, approximately 1 in 5 had clinically significant scores on the CBCL and the CBCL-TRF. Among children 18 months to 3 years, there was a trend to lower CBCL externalizing-symptom scores.

The association was reported by both parents and caregivers and persisted even after researchers controlled for the non deployed parent's stress and depression symptoms.

"Larger longitudinal studies are needed to confirm these results and to fully describe the impact of parental deployments — from deployment to reunification — on young children," Dr. Chartrand said.

"Further research is also needed to ensure that we are providing the proper level of assistance to military families during deployments," she added.

Kudos to Investigators

In an accompanying editorial, David J. Schonfeld, MD, and Robin Gurwitch, PhD, from the Cincinnati Children's Hospital Medical Centre, in Ohio, say the study investigators should be applauded for their research efforts. "There is a pressing need for a systematic assessment and ongoing evaluation of how families, including young children, are adjusting to parents' deployment," they note.

"The observation that approximately 1 in 5 children was already demonstrating clinically relevant scores on behavioural measures completed by parents and childcare teachers an average of 3.9 months after parents were deployed should be seen as highly concerning," the authors write.

"Findings from this study highlight the need for increased attention to the mental-health concerns of young children of deployed soldiers as well as the mental-health concerns of the soldiers and non deployed spouses," they add. "They raise questions of how to best determine deployment length and what preventive measures can be taken to reduce stress and distress in the non deployed spouses and children left behind."

The study was supported by the Joel and Barbara Alpert Foundation and the Society for Developmental and Behavioral Pediatrics; Reach Out and Read provided books. The study authors and the editorialists have disclosed no relevant financial relationships.