Healing Soldiers & Helping Families

What are the typical patterns of how children respond to a parent with PTSD?

Researchers have observed a direct relationship between each of the parent's PTSD symptoms and the children's responses. Researchers also have noticed patterns in the ways children respond to the parent's overall presentation of PTSD. Harkness (1991) described three typical ways these children respond:

(1) the over-identified child: the child experiences secondary traumatization and comes to experience many of the symptoms the parent with PTSD is having;

(2) the rescuer: the child takes on parental roles and responsibilities to compensate for the parent’s difficulties; and

(3) the emotionally uninvolved child: this child receives little emotional support, which results in problems at school, depression and anxiety, and relational problems later in life.

These theories certainly do not represent every possible reaction children may have to parents with combat-related PTSD, but they offer some useful ways of understanding how symptoms might develop for these children.

What are the common problems children of veterans with PTSD face?

Social & behavioral problems

Research has shown that there is significantly more violence in families of Vietnam veterans with PTSD than in families of veterans without PTSD, including increased violent behavior of the child. Several studies have examined the effect that fathers' combat-related PTSD and violent behaviors have on their children. Results have generally revealed that children of veterans with PTSD are at higher risk for behavioral, academic, and interpersonal problems. Their parents tend to view them as more depressed, anxious, aggressive, hyperactive, and delinquent compared to children of non-combat Vietnam era veterans (who do not have PTSD). In addition, the children are perceived as having difficulty establishing and maintaining friendships. Chaotic family experiences can make it difficult to establish positive attachments to parents, which can make it difficult for children to create healthy relationships outside the family too. There is also research showing that children may have particular behavioral disturbances if their parent veteran participated in abusive violence (i.e., atrocities) during combat service.

Emotional problems and secondary traumatization

Results have also shown that children of veterans with PTSD are at higher risk for being depressed and anxious than non-combat Vietnam era veteran's children. Children may start to experience the parent's PTSD symptoms (e.g., start having nightmares about the parent's trauma) or have PTSD symptoms related to witnessing their parent's symptoms (e.g., having difficulty concentrating at school because they're thinking about the parent's difficulties). Some researchers describe the impact that a parents PTSD symptoms have on a child as secondary traumatization. However, because of the increased likelihood that violence occurs in the home of a veteran with PTSD, it is also possible that children develop PTSD symptoms of their own. Having a seemingly unsupportive parent can compound these symptoms.

Problems may continue into adolescence

Adolescent children of veterans with PTSD may also be affected by their parent's symptoms. Compared to adolescent children of non-veteran fathers, adolescent children of Vietnam combat veteran fathers show poorer attitudes toward school, more negative attitudes toward their fathers, and higher levels of depression and anxiety. They also receive lower scores on creativity. Adolescent children of Vietnam combat veterans may also have more problematic behaviors as rated by their mothers, although their behavior at school does not show evidence of disturbance. In spite of these differences, the two groups of adolescents were actually quite similar on a range of other measures of social and personality adjustment. One of the potential reasons for the limited impact on this group of adolescents is that the fathers in this study experienced combat but were not actually diagnosed with PTSD. It seems that children of combat veterans may struggle with some psychological and behavioral difficulties, but higher levels of impairment are much more likely when the veteran is struggling with mental health issues of his/her own, such as PTSD.

Can children get PTSD from their parents?

It is possible for children to display symptoms of PTSD because they are upset by their parent's symptoms (secondary traumatization). Some researchers have also investigated the notion that trauma and the symptoms associated with it can be passed from one generation to the next. Researchers describe this phenomenon as intergenerational transmission of trauma. Much research has been conducted with victims of the Holocaust and their families (see Kellerman for review), and some studies have expanded on these ideas to include families of combat veterans with PTSD.

Ancharoff, Munroe, and Fisher described several ways to understand the mechanisms of intergenerational transmission of trauma. These mechanisms are silence, overdisclosure, identification, and reenactment.

What should I do if I feel my or my partner's PTSD is affecting my children?

Parents can help children by using the information provided in this fact sheet and in the resources identified below. Preventive interventions can be helpful and include explaining to family members the possible impact of intergenerational transmission of trauma, before it happens. Education about the potential impact on children can also be a useful reactive response, when a child is already being affected by his or her parent's trauma history.

An excellent first step in helping children cope with a parent's PTSD is to explain the reasons for the traumatized parent's difficulties, without burdening the child with graphic details. It is important to help children see that the symptoms are not related to them; children need to know they are not to blame. How much a parent says should be influenced by the child's age and maturity level. Some parents may prefer to have help with what they say to their children, and seeking assistance through therapy or written materials can be helpful. The National Center for PTSD's fact sheet below on "Children and disaasters" can help parents talk to children about trauma. This fact sheet also describes how children may react differently, depending on the child's age.

In addition to this basic first step, there are multiple treatment options available for affected families. Treatment can include individual treatment for the veteran (symptom improvement for the person suffering from PTSD would indirectly benefit the family) and family therapy (to support the parent who is struggling with symptoms and teach family members how to get their own needs met). Family therapy is typically more effective if the veteran with PTSD has first received some type of trauma therapy such that he or she is better able to focus on helping the children during family sessions. Children may benefit from individual therapy as well, with variations based on the child's age (e.g., art or play therapy for younger children, supportive talk therapy for older children and adolescents). Each family is unique, and decisions about what kind of treatment to seek, if any, can be complicated. The most important thing is to help each member of the family, including the children, have a voice in expressing what he or she needs. In light of the recent research showing the negative impact PTSD can have on families, Veterans Affairs PTSD programs ( http://www.va.gov) and Vet Centers ( http://www.va.gov/rcs/) across the country are beginning to offer group, couples, and individual programs for families of veterans.

Taken from article posted on the web: