Department of Psychology and Gonda Brain Sciences Center, Bar-Ilan University, Ramat-Gan, Israel.
J Am Acad Child Adolesc Psychiatry. 2011 Jul;50(7):645-58. doi: 10.1016/j.jaac.2011.03.001. Epub 2011 Apr 29.
Although millions of the world's children are growing up amidst armed conflict, little research has described the specific symptom manifestations and relational behavior in young children exposed to wartime trauma or assessed factors that chart pathways of risk and resilience.
Participants included 232 Israeli children 1.5 to 5 years of age, 148 living near the Gaza Strip and exposed to daily war-related trauma and 84 controls. Children's symptoms were diagnosed, maternal and child attachment-related behaviors observed during the evocation of traumatic memories, and maternal psychological symptoms and social support were self-reported.
PTSD was diagnosed in 37.8% of war-exposed children (n = 56). Children with PTSD exhibited multiple posttraumatic symptoms and substantial developmental regression. Symptoms observed in more than 60% of diagnosed children included nonverbal representation of trauma in play; frequent crying, night waking, and mood shifts; and social withdrawal and object focus. Mothers of children with PTSD reported the highest depression, anxiety, and posttraumatic symptoms and the lowest social support, and displayed the least sensitivity during trauma evocation. Attachment behavior of children in the Exposed-No-PTSD group was characterized by use of secure-base behavior, whereas children with PTSD showed increased behavioral avoidance. Mother's, but not child's, degree of trauma exposure and maternal PTSD correlated with child avoidance.
Large proportions of young children exposed to repeated wartime trauma exhibit a severe posttraumatic profile that places their future adaptation at significant risk. Although more resilient children actively seek maternal support, avoidance signals high risk. Maternal well-being, sensitive behavior, and support networks serve as resilience factors and should be the focus of interventions for families of war-exposed infants and children.
尽管全世界有数百万儿童在武装冲突中成长，但很少有研究描述过暴露于战时创伤的幼儿的具体症状表现和关系行为，也很少有研究评估过导致风险和恢复力的因素。
参与者包括 232 名 1.5 至 5 岁的以色列儿童，其中 148 名居住在加沙地带附近，每天都受到与战争相关的创伤，84 名作为对照组。对儿童的症状进行诊断，在唤起创伤记忆时观察母婴依恋相关行为，以及母亲的心理症状和社会支持情况则由其自我报告。
37.8%（n=56）的战争暴露儿童被诊断患有 PTSD。患有 PTSD 的儿童表现出多种创伤后症状和严重的发育倒退。在 60%以上被诊断为患有 PTSD 的儿童中观察到的症状包括：在游戏中用非言语方式表达创伤；频繁哭泣、夜醒和情绪变化；以及社会退缩和对物体的关注。患有 PTSD 的儿童的母亲报告了最高的抑郁、焦虑和创伤后症状以及最低的社会支持，并且在唤起创伤时表现出最低的敏感性。暴露于 PTSD 儿童组的儿童依恋行为特征是使用安全基地行为，而患有 PTSD 的儿童则表现出更多的行为回避。母亲而不是孩子的创伤暴露程度和母亲的 PTSD 与孩子的回避行为相关。
大量反复暴露于战时创伤的幼儿表现出严重的创伤后特征，使他们未来的适应面临重大风险。尽管更有韧性的儿童积极寻求母亲的支持，但回避信号表明存在高风险。母亲的幸福感、敏感行为和支持网络是恢复力的因素，应成为干预战争中暴露于创伤的婴儿和儿童家庭的重点。
