A Comprehensive Approach to Supporting Children's Mental Health in the Wake of Armed Conflict

The early years of childhood and adolescence are crucial for development, bringing about significant changes in mental, social, physical, and emotional well-being (Garcia-Carrion, Villarejo-Carballiso & Villardon-Gellgo, 2019)). During this time, the brain undergoes extensive growth, making individuals particularly responsive to their surroundings. In infancy and early childhood, the central nervous system (CNS) is in a vulnerable state, and exposure to stress during critical periods can lead to short- and long-term issues in physiology, cognition, and behavior (de Figueiredo et al., 2021). It's worth noting that the prefrontal cortex, responsible for critical thinking and impulse control, isn't fully developed until around 25 years old.

The environment in which children grow plays a crucial role in shaping their well-being. Negative experiences like exposure to violence, a caregiver's mental illness, bullying, or poverty increase the risk of mental health problems (Das et al., 2016). The severity of these issues tends to escalate with the intensity of trauma, especially from violence. Weaknesses in prevention activities and limited access to affordable treatment further complicate the situation (World Health Organization).

The mental health burden resulting from conflict-related neglect, abuse, and exploitation is particularly concerning, leading to disparities between the mental health of war-affected children and the general population (Slone & Man, 2016).

Experiencing armed conflict during childhood poses serious mental health risks. The most common disorders reported are PTSD and depression, with other issues like ADHD, panic disorder, anxiety disorders, and sleep disorders also prevalent (Catani, 2018). Children exposed to conflict-related trauma are prone to externalizing symptoms, including behavioral problems (Halevi et al., 2016). These challenges often persist, and symptoms may increase with age, with school-age children being the most vulnerable (Shaw, 2003).

The impact of armed conflict extends through a child's social and developmental environment, affecting family interactions, peer relations, education, and overall life satisfaction (Reed et al., 2012). Conflict-related stigma exacerbates mental health problems in post-conflict settings (Miller & Rasmussen, 2010).

Encouragingly, longitudinal evidence suggests that protective factors like family and community acceptance can mitigate the negative effects of war, reducing the risk of mental disorders and promoting psychosocial functioning (Betancourt et al., 2020). Caring adults, especially within the parent-child relationship, play a critical role. It's essential to address caregivers' needs for information about normal and maladaptive reactions to traumatic events and provide resources for assistance.

Recognizing signs of traumatic stress in children is crucial, as they vary by age. Preschoolers may fear separation, cry a lot, and have nightmares, while elementary school children may struggle with sleep, nightmares, and avoidance. Middle and high school children might avoid situations that trigger memories, experience nightmares or flashbacks, and act impulsively or aggressively.

Strategies for helping children exposed to war or trauma include:

Prioritize safety first. The advice below applies only when everyone is safe from physical harm. If you're struggling to meet basic needs like shelter, food, sleep, and safety, focus on addressing these essential needs first.

Explain that these reactions are normal. Help kids understand that feelings such as worry, sadness, anger, or confusion are normal and understandable given what they've been through. Many children hide their emotions, thinking they are alone in feeling this way. If you're feeling anxious, it's okay to share that with them. Encourage open communication about feelings.

Teach yourself and your child about trauma reactions. Help children recognize that certain reminders or "triggers" can cause intense feelings. These triggers can come from any of the five senses or anything that reminds them of the event. Understanding triggers and responses can reduce confusion, increase a sense of control, and connect thoughts and feelings.

Help your child cope with trauma reactions. Identify things that trigger significant reactions and plan for healthy coping strategies. Children may develop unhealthy coping mechanisms like suppressing emotions or distancing themselves. Encourage them to become comfortable with their feelings, praising positive behaviors and using positive self-talk statements.

Praise behaviors you want to see more of. Dedicate time each day to acknowledge positive behaviors, such as kindness, emotional management, and cooperation. Avoid giving attention to negative behaviors, focusing on positive reinforcement. For children acting out aggressively, prioritize praising gentle behavior.

Help kids relax. Traumatic events can make kids feel constantly tense, and their brains may overreact to perceived dangers. Teach children relaxation techniques like slowing breathing, tensing and relaxing muscles, or engaging in activities that bring joy. Encourage them to use these strategies when feeling tense or stressed.

Help kids gradually approach reminders of trauma. Collaborate with your child to approach memories or safe situations that remind them of the trauma. This can involve writing or talking about the event to make sense of it. Gradually approaching these reminders, starting with easier situations, allows children to navigate their emotions with support and encouragement.

Never force your child to confront trauma reminders before they're ready. Start with easier situations, progressing to more challenging ones as your child gains confidence (Anxiety Canada, 2023).

Recognizing and addressing the challenges that children encounter in the aftermath of armed conflict is paramount for their overall well-being and development. The pivotal role of caring adults, particularly within the parent-child relationship, cannot be overstated in navigating post-conflict adversities. By embracing these multifaceted approaches, we can contribute to a more resilient and supportive environment for children affected by the repercussions of armed conflict, fostering their journey towards recovery and well-being.

 

Sources:

Betancourt, T. S., Thomson, D. L., Brennan, R. T., Antonaccio, C. M., Gilman, S. E., & VanderWeele, T. J. (2020). Stigma and acceptance of Sierra Leone’s child soldiers: A prospective longitudinal study of adult mental health and social functioning. Journal of the American Academy of Child & Adolescent Psychiatry, 59(6), 715–726. https://doi.org/10.1016/j.jaac.2019.05.026

Catani, C. (2018). Mental health of children living in war zones: A risk and protection perspective. World Psychiatry, 17(1), 104–105. https://doi.org/10.1002/wps.20496

Das, J. K., Salam, R. A., Lassi, Z. S., Khan, M. N., Mahmood, W., Patel, V., & Bhutta, Z. A. (2016). Interventions for adolescent mental health: An overview of Systematic Reviews. Journal of Adolescent Health, 59(4). https://doi.org/10.1016/j.jadohealth.2016.06.020

de Figueiredo, C. S., Sandre, P. C., Portugal, L. C., Mázala-de-Oliveira, T., da Silva Chagas, L., Raony, Í., Ferreira, E. S., Giestal-de-Araujo, E., dos Santos, A. A., & Bomfim, P. O.-S. (2021). Covid-19 pandemic impact on children and adolescents’ mental health: Biological, environmental, and social factors. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 106, 110171. https://doi.org/10.1016/j.pnpbp.2020.110171

García-Carrión, R., Villarejo-Carballido, B., & Villardón-Gallego, L. (2019). Children and adolescents’ mental health: A systematic review of interaction-based interventions in schools and communities. Frontiers in Psychology, 10. https://doi.org/10.3389/fpsyg.2019.00918

Halevi, G., Djalovski, A., Vengrober, A., & Feldman, R. (2016). Risk and resilience trajectories in war‐exposed children across the first decade of life. Journal of Child Psychology and Psychiatry, 57(10), 1183–1193. https://doi.org/10.1111/jcpp.12622

Helping youth with war-related stress. Anxiety Canada. (2023, January 20). https://www.anxietycanada.com/articles/helping-youth-with-war-related-stress/

Miller, K. E., & Rasmussen, A. (2010). War exposure, daily stressors, and mental health in conflict and post-conflict settings: Bridging the divide between trauma-focused and psychosocial frameworks. Social Science & Medicine, 70(1), 7–16. https://doi.org/10.1016/j.socscimed.2009.09.029

Reed, R. V., Fazel, M., Jones, L., Panter-Brick, C., & Stein, A. (2012). Mental health of displaced and refugee children resettled in low-income and middle-income countries: Risk and protective factors. The Lancet, 379(9812), 250–265. https://doi.org/10.1016/s0140-6736(11)60050-0

Shaw, J. A. (2003). Children exposed to war/terrorism. Clinical Child and Family Psychology Review, 6(4), 237–246. https://doi.org/10.1023/b:ccfp.0000006291.10180.bd

Slone, M., & Mann, S. (2016). Effects of war, terrorism and armed conflict on young children: A systematic review. Child Psychiatry & Human Development, 47(6), 950–965. https://doi.org/10.1007/s10578-016-0626-7

World Health Organization. (n.d.). Trauma among children who are victims of violence. World Health Organization. https://www.afro.who.int/news/trauma-among-children-who-are-victims-violence