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Children in Military Families 1

Supporting Children During Deployment in Military Families:

An Attachment Theory Perspective

Jane Slomski SSS 804: Social Work With Children November 23, 2009

Children in Military Families 2

Introduction Following the terrorist attacks of September 11, 2001, the lives of U.S. service members and their families changed dramatically. Thousands were deployed to Iraq and Afghanistan as the United States, along with its allies, waged the Global War on Terror (GWOT) (Doyle & Petersen, 2005). Eight years later, Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) have become part of the most sustained wartime effort on the part of the U.S. military since the Vietnam War (Doyle & Petersen, 2005). Due to the extended nature of the mission, some U.S. service members, particularly members of the Army, have served as many as four tours of duty in these volatile areas of the world. The face of the U.S. military is changing. Today, sixty percent of U.S. troops have family responsibilities. This was not always the case. Historically, the military was made up of single men, so there was little to no need to be concerned about families or children (Drummet, Coleman, & Cable, 2003). With the transition to an all volunteer military, this changed but was not immediately accompanied by a change in military policy surrounding family life. For the most part, families were expected to adapt to military norms and to the demands of the military lifestyle. In recent times, these norms and demands have been met with increasing intolerance and dissatisfaction (Drummet, Coleman, & Cable, 2003), necessitating a reevaluation of military policies, procedures, and services to make the military more appealing and to maintain an adequate national defense. Repeated deployments and exposure to trauma have been taxing for our troops and their families. The effects of pre-deployment, deployment, and post-deployment

Children in Military Families 3 stressors on service members and their families is well documented and should be understood by helping professionals who work with children who may be affected by the deployment of a close friend or family member (Murray, 2002). Children and caregivers in military families commonly report problematic symptoms due to experiences of stress, anxiety, separation from family members, loss, and grief. As a theory that directly addresses these issues, attachment theory (Bowlby, 1969) which focuses on the importance of childrens attachment to caregivers for psychosocial well-being, is uniquely suited to aid the mental health professional in understanding the etiology of these symptoms. Further, interventions informed by attachment theory may be helpful in treating children who present with these issues in a social work setting. Stressors in Military Families and the Effects on Caregivers Military families are a unique population. In addition to the day-to-day stressors that affect all families, military families contend with specific stressors that are unique to the military lifestyle including repeated relocations, frequent separation, deployment of service members-sometimes to dangerous locations, reorganization of family life, and risk of service member injury or death (Burrell, Adams, Durand, & Castro, 2006; Drummet, Coleman, & Cable, 2003). Not surprisingly, fear for soldier safety is the most commonly reported stressor of spouses in the military, particularly when the service member is deployed to a combat zone (Cozza, Chun, & Polo, 2005). It is logical to begin any discussion of the psychosocial well=being of children with a discussion of the psychosocial well-being of the adults who care for them. RyanWenger (2002) notes that children whose parents are deployed generally exhibit sub-

Children in Military Families 4 clinical levels of psychological distress. The bulk of the literature suggests that overall, children in the military learn to cope and adapt to the stressors placed on them by the military. During the deployment of their parents military youth have demonstrated significant resiliency and the ability to adapt, have demonstrated greater maturity than their civilian cohorts, are aware of the dangers surrounding deployment, and feel a strong sense of sacrifice and patriotism (Lemmon & Chartrand, 2009). However, childrens psycho-social well-being is mediated by levels of parental psychopathology at home. If the caregiver in the home does not react well to the deployment of the service member parent, experiencing anxiety, depression, or stress, the children may also experience clinically significant levels of distress, anxiety and depression (Chartrand, Frank, White, & Shope, 2008). In a correlational study between military stressors and a number of factors related to psychosocial well-being, Burrell, Adams, Durand, & Castro (2006) surveyed spouses of service members and found that fear for soldier safety was negatively correlated with psychological well-being, physical well-being and satisfaction with the army. Interestingly, this study examined the impact of separations. They found that impact of separations was the single variable out of all of the variables investigated that predicted all of the four outcomes, namely satisfaction with army life, physical well-being, psychological well-being, and marital satisfaction. Impact of separations refers to the effect that the soldiers deployment has on the family life cycle. If deployment causes separation during important life events or holidays, the spouse is likely to report decreased physical well-being, decreased psychological well-being, decreased marital satisfaction, and decreased satisfaction with army life.

Children in Military Families 5 Attachment and Separation Attachment theory, first proposed by John Bowlby (1969) expands on the idea that human beings rely on emotional and physical connections with other people in order to be psychologically healthy. The attachment system is immediately active in newborns. Infants seek food, warmth, and safety through proximity to attentive caregivers, and the developing attachment system continues to be an important aspect of psychosocial functioning throughout life (Mikulincer & Shaver, 2007). A childs first attachment figures are usually their parents, and the primary attachment figure is usually the mother. However, in the absence of a biological parent, an attachment bond may exist with a significant person who spends quality time with and plays an important role in a childs life (Cassidy & Shaver, 1999). Within the broad lens of attachment, there are several different attachment styles, or patterns of relating between caregivers and children (Mikulincer & Shaver, 2007). Mary Ainsworth developed the Strange Situation Procedure to examine the effects of separation from attachment figures on children. In the Strange Situation Procedure, mothers and children are observed in a laboratory playroom. The mother leaves the room for a short period of time and the childs reactions to her leaving and returning are observed. Based on her observations, she classified attachment into four basic categories: secure, avoidant, anxious, and disorganized (Mikulincer & Shaver, 2007). In secure attachment, the child feels safe and secure with the attachment figure and is comfortable turning to them in times of distress. They are comfortable exploring the world with the knowledge that the attachment figure will be available for protection if the external environment becomes stressful, dangerous or overwhelming (Mikulincer &

Children in Military Families 6 Shaver, 2007). Upon separation from an attachment figure, the securely attached child responds with crying and emotional distress, but is able to regain equilibrium and continue exploring their environment. When the attachment figure returns, the child greets the person with joy and proximity seeking behaviors, but quickly returns to exploring the environment. The securely attached parent responds appropriately to the childs physical and emotional needs, providing the basic necessities of life when the child is an infant and encouraging exploration as the child develops, always with the understanding that they will be available if needed (Mikulincer & Shaver, 2007). Children with an avoidant attachment style seem to be somewhat uncomfortable getting close to attachment figures. They do not trust easily, show little distress when separated from an attachment figure and are uninterested when she returns (Mikulincer & Shaver, 2007). Avoidant caregivers are observed to be emotionally rigid and may become angry or rejecting of their childs bids for closeness. Anxiously attached children are extremely distressed when separated from their attachment figures, but display conflicted or ambivalent responses upon reunion. Anxiously attached caregivers do not give consistent responses to their childs proximity-seeking behaviors and the home environment is characterized by a general lack of harmony (Mikulincer & Shaver, 2007). In disorganized attachment, children may switch rapidly from extreme distress when separated from caregivers, to ambivalence. They might exhibit both proximityseeking behaviors and avoidant or ambivalent behaviors upon reunion. In some situations, they may remain passive and not exhibit any outward signs of proximity seeking. Caregivers of children with disorganized attachment are observed as unpredictable and disorganized in their own behavior. They often space out when their

Children in Military Families 7 child approaches them, or they may look frightened or confused. Researchers speculate that adults with disorganized attachment styles most likely suffer from unresolved losses, attachment injuries, or trauma (Mikulincer & Shaver, 2007). According to attachment theory, prolonged separation from these important attachment figures, regardless of attachment style, causes marked psychological and physical distress. The effects of separation from attachment figures on childrens wellbeing has been the subject of much research and debate. Deployment Separation & the Effects on Children Prolonged separation from an attachment figure is one of the most stressful events a child can experience, particularly when the caregiver (most often the father) goes to war. Due to frequent relocations and deployment, children in military families often experience separation from their parents and from their communities, schools, and friends. If the deployed parent is a primary attachment figure, children may exhibit various internalizing and externalizing behaviors including fear, anxiety, aggression, and depression in response to the perceived loss of the attachment figure (Cassidy & Shaver, 1999). Children experience and respond to separation in different ways depending upon their developmental level. Murray (2002) describes common age-specific reactions to separation. Infants react to the emotions of their primary caregivers. If caregivers are stressed, depressed, or anxious, infants may become inactive, unresponsive, hypervigilant, or irritable. Spouses of deployed service members with children often report changes in their infants behavior, including changes in eating habits, sleeping, and increased crying. Toddlers who experience the deployment of a caregiver will often react with

Children in Military Families 8 increased clinging, withdrawal, or depression. They may have difficulty sleeping and may not want to associate with other children. Preschoolers may regress to earlier developmental behaviors including bed wetting, fussing, crying for attention, and increased aggression. Because they lack an understanding of cause and effect, preschoolers may mistakenly believe that they caused the parent to leave and may experience feelings of guilt as a result of this belief. Practitioners who work with this age group should be aware that this belief may exist, as the child is unlikely to share it with an adult (Murray, 2002). Children who are 6-8 years old have a better understanding of cause and effect, and may experience intense grief. Especially with a basic understanding of terrorism, exposure to the media, and a basic understanding of the meaning of the current war, children in this age group may fear for their own safety (especially if they turned to the deployed soldier as a primary attachment figure for safety) and fear that their caregivers will leave them. They may experience difficulty sleeping, problems in school, and may show increased clinging behaviors (Murray, 2002). 9-12 year-olds may experience a whole range of emotions related to the deployment of a parent. They can feel a compelling sense of loss and feel happy, troubled, angry, or sad, all within a relatively short period of time. Boys in this age group may feel a sense of responsibility for taking on the role of the deployed parent, particularly if the father is deployed. Simultaneously, they may feel anger toward the deployed parent and feel abandoned. These feelings may manifest in increased aggression, antisocial behavior, or in increased involvement in extracurricular activities in an attempt to hide their emotions (Murray, 2002).

Children in Military Families 9 The Effects of Deployment on Attachment Bonds The Internet and modern technology have made it possible for deployed troops to stay in contact with their families like never before. E-mail, instant messaging, and web cams help to maintain the psychological presence of the soldier in the home and in the minds of his/her family members. Nevertheless, attachment bonds between parents and children and between spouses are tested by deployment. Troops are often in areas of the world where Internet access is not available. In some cases, the deployed parent may not be able to tell his/her family where they are. (Huebner, Mancini, Bowen, & Orthner, 2009). In addition, 40% of U.S. service members who are currently deployed have children under the age of 5 (Chartrand, Frank, White, & Slope, 2008). Particularly in the Army, where the average deployment cycle is 12-18 months, a soldier may leave an infant and come back to a young child who does not remember or recognize him/her (Allen & Staley, 2007). He/she has missed a year of the childs life and of all of the developmental milestones associated with that year. The parent must then attempt to catch up, to reestablish a relationship, and to rebuild attachment bonds that were disrupted by deployment. Children may experience fear, anger, and sadness as a result of their attachment figures perceived unavailability due to deployment and these emotions can become clinically significant if left untreated. Depending upon the childs age and the amount of contact during deployment, a child will react differently to attempts by the parent to seek closeness. If the soldier has sustained injuries, the child may be initially fearful or

Children in Military Families 10 uncertain about how to approach their parent, which may impact how attachment bonds are repaired (Doyle & Petersen, 2005). Attachment Based Social Work Intervention Military and civilian social workers are in an ideal position to help families and children of deployed service members. Attachment theory directly address concerns surrounding children and separation from caregivers and is therefore very useful for intervening with children whose parent is deployed (Cassidy & Shaver, 1999). Children who have experienced deployment of a parent often experience hyperactivation of the attachment system. The normal emotions that accompany threats to an attachment figures availability: fear, anger, and sadness, can manifest as pervasive depressive symptoms, anxiety disorders, aggression, disassociation, and anti-social behavior (Cassidy & Shaver, 1999). Intervention for children who present with behavioral or emotional problems related to the deployment of a parent should focus on the strengthening of attachment bonds between children and the caregiver at home, reassurance of safety and security, the maintenance of the attachment bond between children and the deployed parent, and the strengthening or repair of attachment bonds when the soldier returns home (Cassidy & Shaver, 1999). Otherwise disruptions in secure attachment relationships can lead to anxious feelings and anxious attachment (Cassidy & Shaver, 1999). For very young children, play therapy may be the only appropriate modality for attachment-based treatment. The clinician should be aware of the presence of themes in childrens play including war, violence, separation, control, and death that may signify underlying attachment issues. For older children, more direct

Children in Military Families 11 conversations about fear, sadness and anger related to deployment and war can be helpful. Children should be encouraged to express their emotions related to deployment (Lemmon & Chartrand, 2009). In addition, clinicians can work with parents to promote healthy attachment to caregivers in the home and on deployment. Parents should be encouraged to listen to their children about their feelings regarding war and deployment. Whenever possible, the family should maintain regular contact with the soldier. Regular and predictable contact can be a great protective factor for the attachment relationship, but may not always be a realistic possibility given the location of the soldier and the mobility of the soldiers unit (Drummet, Coleman, & Cable, 2003). Rituals are another concrete way to strengthen attachment bonds between parents and children while a parent is deployed. Often when a parent goes to war, family responsibilities are rearranged and family schedules become unpredictable and erratic (Drummet, Coleman, & Cable, 2003). A way to alleviate stress of deployment on the family, and to strengthen attachment bonds, is to engage in meaningful rituals that are concrete and predictable (B. Bailey, personal communication, October 23, 2009). Possibilities include bedtime rituals, morning rituals, and rituals surrounding talking to the deployed parent while the parent is away. The deployed parent might always begin the conversation the same way when talking on the phone, or the caregiving parent might always read the same story before bedtime. Rituals add predictability and stability to the home environment, build attachment bonds, and can be continued when the deployed parent returns (B. Bailey, personal communication, October 23, 2009).

Children in Military Families 12 Implications Mental health treatment in the military is still an evolving field. As more soldiers return from Afghanistan and Iraq, more of the American community is taking notice of the needs of military families and their children. Many veterans are being diagnosed with post-traumatic stress disorder (PTSD) and it is estimated that many others live with subclinical symptoms of the disorder (Drummet, Coleman, & Cable, 2003). Veterans living with untreated mental illness have more difficulty integrating back into family and civilian life. Because childrens symptomology is inextricably linked to parents psychopathology, children may begin to exhibit behavioral and emotional symptoms that are indicative of family issues (Doyle & Peterson, 2005). The military has come a long way in its treatment of soldiers families and children. More services are available in the military community and there is less of a stigma attached to the seeking of behavioral health and counseling services (J. Patrick CW2, U.S. Army, personal communication, September 28, 2009). As childrens psychopathology is linked to parental psychopathology, it is imperative that military and civilian social workers encourage soldiers to get mental health treatment when needed. Limitations Attachment theory is informed by relational and psychodynamic theories and so may not adequately address the impact of environmental aspects on the childs behavior. In situations in which a childs maladaptive behaviors are severe enough to warrant intervention, the clinician would benefit from examining the case

Children in Military Families 13 through a behavioral lens. Behavioral interventions including the setting of behavioral limits, and a more structured environment may help children to cope with deployment of a parent. In addition to attachment theory and behavioral theory, clinicians would benefit from examining the family from a family systems perspective. Examine the micro and macro systems surrounding the family unit, as well as the boundaries between systems. Is the family an open or closed system? Are they willing to go to the community for support? Has deployment placed undue financial strain on the family? Are adult members of the family currently suffering from mental illness? Are there co-occurring stressors such as the birth, death or illness of a family member that might make the deployment particularly difficult? The unique advantage of the social work profession is the ability to examine the family from the person-in-environment perspective. Other important variables that might affect the well-being of the deployed family member or of the family itself include availability of social supports and community connectedness. If the family has just relocated, they may not be familiar with the surrounding area and resources and will be far away from supportive friends and family members. If the children have just started at a new school, academic performance and social adjustment may be negatively affected not only by the deployment, but by the move itself. For these reasons a social worker should not limit examination of a case to a single theory base. Attachment theory may only address part of the problem in psychosocial functioning experienced by the family and the soldier.

Children in Military Families 14 As the wars in Iraq and Afghanistan continue and more soldiers are returning home to their families, military and civilian social workers and other mental health professionals will be increasingly called upon to provide their services to a growing number of military and civilian personnel. It is therefore imperative that social work practitioners advocate effectively and implements successful treatment models for military families and children.

Children in Military Families 15 References Allen, M. & Staley, L. (2007, January). Helping children cope when a loved one is on military deployment. Retrieved from Bowlby, J. (1969). Attachment and loss. Basic Books. Burrell, L.M., Adams, G.A., Durand, D.B. & Castro, C.A. (2006). The impact of military lifestyle demands on well-being, army, and family outcomes. Armed Forces & Society, 33(1). 43-58. Cassidy, J. & Shaver, P.R. (Eds.).(1999). Handbook of attachment: Theory, research, and clinical applications. New York: The Guilford Press. Chartrand, M.M., Frank, D.A., White, L.F., & Shope, T.R. (2008). Effects of parents wartime deployment on the behavior of young children in military families. Journal of Pediatric and Adolescent Medicine, 162(11). 1009-1114. Cozza, S.J., Chun, R.S., & Polo, J.A. (2005). Military families and children during Operation Iraqi Freedom. Psychiatric Quarterly, 76(4). 371-378. Doyle, M.E. & Petersen, K.A. (2005). Re-entry and reintegration: Returning home after combat. Psychiatric Quarterly, 76 (4). 361-370. Drummet, A. R., Coleman, M., & Cable, S. (2003). Military families under stress: Implications for Family Life Education. Journal of Family Relations, 52, 279287. Huebner, A.J., Mancini, J.A., Bowen, G.L. & Orthner, D.K. (2009). Shadowed by war: building community capacity to support military families. Journal of Family Relations, 58, 216-228.

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Lemmon, K.M. & Chartrand, M.M. (2009). Caring for Americas children: Military youth in time of war. Pediatrics in Review, 30(6). 42-48. Mikulincer, M. & Shaver, P.R. (2007). Attachment in adulthood: Structure, dynamics, and change. New York: Guilford Press. Murray, J.S. (2002). Helping children cope with separation during war. Journal for Specialists in Pediatric Nursing, 7(3). 127-130. Ryan-Wenger, N.A. (2002). Impact of the threat of war on children in military families. Journal of Pediatric Health Care, 16, 245-252.