Serving the Children of Those Who Serve

Barbara Van Dahlen, Ph.D. is a licensed clinical psychologist and the founder and president of Give an Hour

The end of summer signals the return to school for children across the country. Typically, the start of school is a time to reconnect with friends, focus on the latest fashion trend, choose a fall sport, and settle in for a year of exploration and—one hopes—learning. Unfortunately, recent reports indicate that many of our military children are currently experiencing significant levels of stress that will likely interfere with their participation in and enjoyment of normal childhood experiences including heading back to school. Indeed, children of U.S. troops sought outpatient mental health care 2 million times in 2008—twice the number of visits utilized by this population at the start of the Iraq war. An article published by the Associated Press (August 9, 2009) notes a Pentagon report indicating a 20 percent increase in the number of active duty dependent children hospitalized for mental health needs between 2007 and 2008. Since the invasion of Iraq in 2003, inpatient treatment for children in the military is up by 50 percent.

How are we to understand the current trend in the request for mental health services for the children of those who serve? It is likely that several factors are contributing to this change. One positive factor may be that some military leaders, as well as the current administration, have been very outspoken about the need for those in the military to seek mental health care. Admiral Mullen and Secretary Gates come to mind immediately, and both the President and Mrs. Obama have shown impressive leadership in this area. Perhaps the message is filtering through the system and families are feeling more comfortable seeking care for themselves and their children. While increased comfort may account for some of the change we have seen, it is unlikely that it explains the whole story. Several current elements clearly place children in the military at risk for psychological and behavioral difficulties.

Specifically, the chronic nature of the conflicts in Iraq and Afghanistan is having a cumulative and deleterious effect on our military community. We saw an alarming increase in the suicide rate among Army personnel in 2008. Numbers released this month in a New York Times article suggest that 2009 will see an even greater number of suicides within the Army.

Clearly, those within the military seem to be feeling stress, strain and, at times, despair. It follows that the children of those who serve absorb the pain and distress experienced by those around them. Children are like little indiscriminate sponges, absorbing the positive or negative emotional environment within which they live. When parents are preoccupied or unable to function effectively because of their distress, children do not receive the consistent guidance, nurturance, and attention they so desperately need to develop and thrive.

Moreover, children with a parent suffering from untreated post-traumatic stress develop symptoms of post-traumatic stress themselves. In fact, we refer to these children (and military spouses as well) as suffering from “secondary trauma.” We also see an increase in the use and abuse of substances among children whose parents are substance abusers. As some of our returning troops turn to substance abuse as a way to cope with symptoms of anxiety, depression, traumatic brain injuries, and post-traumatic stress, their children are placed at great risk for turning to substance abuse as a coping mechanism.

And then there is the strain on the families who welcome home a loved one who has been physically injured in the war. In this situation, children must cope with a variety of stressors that can overwhelm their developing systems. They must come to terms with the loss of the parent they knew. This is a very difficult task for the adults in the family—those who are injured as well as their spouses. Imagine the difficulty for a child. His or her beloved mother or father comes home missing a limb or is severely scarred from burns, or is unable to concentrate or effectively communicate because of a traumatic brain injury. Depending on the age and maturity of the child, this situation can result in anger, confusion, depression, and anxiety—all of which are perfectly understandable reactions under these circumstances. Without help with this challenge, children can become symptomatic and severely impaired.

Children in families where a parent is injured must often assume a greater level of responsibility, both while the injured parent is at the hospital and once he or she returns home. Often the noninjured parent has stepped into the role of primary caretaker for the injured warrior and needs their child to help with household chores or care for younger siblings. While assuming greater responsibility within the family is not in and of itself a destructive situation for most children, it can interfere with the child’s need to grieve and move through his or her own adjustment.

Some have wondered whether life in the military itself is overly stressful for children. While it is true that on average families within the military move every three years, there is no evidence to suggest that this in itself produces damaged youngsters. In fact, many self-proclaimed “military brats” will proudly discuss the wonderful coping skills—the people skills—they developed as a result of their world travels. Still, moving is stressful for all of us. It isn’t destructive by itself but can be seen as one of a number of stressful events experienced by the current population of military children.

Finally, we must look at the impact of both repeated deployments and repeated experiences of reintegration as contributing factors to symptom development among military children. Even for healthy, intact families—where there are no significant mental health difficulties apparent in either parent—the repeated transition from one family constellation to the other, the chronic worry about the deployed parent, and the potential financial strain on the family can all contribute to the development of anxiety, depression, eating disorders, and behavioral and academic difficulties among the children and teens within our military community.

Our military families need our support during this difficult time. We all have a role to play in this effort and we must be especially concerned about the youngest affected by these wars. As always, children depend on the adults in their lives to give them proper care and attention.

There are steps we can and should take to assist the families who serve our country. First and foremost, we must make easy, accessible mental health care available to all military children who may be suffering as a result of their family’s experience. In addition to the services provided by DoD through the TriCare system, organizations like Give an Hour™ and SOFAR offer critical options for military families in need of mental health care. The National Military Family Association provides special camps for military children, as does TAPS, and Zero to Three offers educational materials and programs for parents of young children to give them the skills they need to help youngsters cope with issues such as deployment and reintegration.

To care for the children in our military community, we must care properly for their parents—and make a long-term commitment to do so. By providing support and education for nondeployed parents, we ensure that these parents are at their best and, therefore, much more likely to maintain their position in the family. With the proper support, these parents will remain the stable figure that provides the love and direction their children both want and need.

Finally, we must continue to educate our communities regarding the issues facing those who come home from war and the issues affecting their families and children. We don’t live in a vacuum. We are surrounded by schools, congregations, employers and neighbors. We must reach out to those who are unfamiliar with the military culture and bridge the gaps that exist in knowledge and awareness. By wrapping our military children in the understanding provided by caring and informed adults, we ensure that they have opportunities to receive help and support from those in their communities who know them best.

Our military children are signaling that they are in distress and in need of attention. To borrow a well worn saying, it really does take a village—and a country—to provide the care they need and deserve.

Give an Hour, providing free mental health services to military personnel and their loved ones, at www.giveanhour.org.

Editors Note: Give an Hour is a strategic partner of Veterans Advantage. Learn more about our partnership with Give an Hour.

Veterans Advantage is also hosting a special online PTSD Transition Center for its members, with customized news and resources to help in this vital area.