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Worries of Military Parents: Understanding and Supporting Children during Deployment

This article discusses the common worries of today's military parents and provides guidance on how to support and reassure them. It also explores the emotional cycle of deployment and the effects on children at different developmental stages.

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Worries of Military Parents: Understanding and Supporting Children during Deployment

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  1. G.W.O.T. Moms and Dads(Global Worries of Today) Scott Uithol, MD & Dawn Uithol, MD USAFP, 2005

  2. Objectives • Be able to list common worries of today’s military parents • To discuss normal from abnormal child behavior • Be able to provide guidance and reassurance to worried parents

  3. The Emotional Cycle of Deployment • Desert Storm  Bosnia/Kosovo  Afghanistan  Iraq • Growing body of experience regarding the impact of extended deployment on military families • 2/3 soldiers married • Emotional cycle of an extended deployment can be divided into 5 stages

  4. The Five Stages • Characterized by time frame and emotional challenges • Pre-deployment • Deployment • Sustainment • Re-deployment • Post-deployment

  5. 1. Pre-deployment • Anticipation of loss vs. denial • Do you really have to go? • Train-up/long hours away • Psychologically deployed • Getting affairs in order • Honey-do lists • Mental/physical distance • “best” holiday, “perfect” vacation, “most” romantic date • Arguments • Ebb-and-flow of marriage vs catastrophic event

  6. 1. Pre-deployment • Discuss in detail their expectations of each other during deployment • Without this: misperception, distortion and hurt later on in the deployment

  7. 2. Deployment(first month away) • Mixed emotions/relief • Disoriented/overwhelmed • Numb, sad, alone • Sleep difficulty • Security issues

  8. 3. Sustainment • New routines established • New sources of support • Feel more in control • Independence • Confidence – “I can do this!”

  9. 3. Sustainment • Communication vulnerable to distortion or misperception • No face to face • Long distances • Unidirectional communication • Email – freeing and filter • Rumors

  10. Children during deployment • Response individualized but depends on developmental stage • It is reasonable to assume that a sudden negative change in a child’s behavior or mood is a predictable response to the stress of having a deployed parent

  11. Infants • < 1 year • Must be held and actively nurtured in order to thrive • Behaviors: refuse to eat, listless • Early intervention becomes critical • Remedy: Support for parent • SWS, ACS, counseling

  12. Toddlers • 1-3 years • Generally take their cue from the primary caregiver • Behaviors: cries, tantrums, irritable, sad • Remedy: increased attention, holding, hugs • Parent time important

  13. Preschoolers • 3-6 years • May regress in their skills • Potty training, “baby talk”, thumb sucking, sleep • Behaviors: potty accidents, clingy, irritable, sad, aggressive, somatic • Remedy: increased attention, holding, hugs, avoid changing routines

  14. School Age Children • 6-12 years • Behaviors: whines, body aches, become aggressive, “act out” their feelings • Remedy: spend time, maintain routines • Expectations regarding school performance may need to be lowered

  15. Teenagers • 13-18 years • Behaviors: isolates, irritable, rebellious, fight, attention-getting behaviors • Increased risk for promiscuity, EtOH, drugs • Remedy: patience, stay engaged, limit-setting, counseling • Additional responsibility in the family can help them feel important and needed

  16. When should parents seek help: • If they are unable to return to at least some part of their normal routine • If they display serious problems over several weeks • Children of deployed parents are more vulnerable to psych hospitalization

  17. Pitfalls during deployment • Over-interpreting arguments • Hot topics/long distances • Rumors/loss of trust • Investment in date of return • Not accepting changes in marriage • Children can cue off of the parent

  18. Helpful Hints during deployment • Establish a base of support • Make plan to break up the time • E-mail/phone calls/letters • Avoid overspending/alcohol • “Single” parents need time without kids

  19. Re-Deployment(month prior to soldier’s return) • Anticipation of homecoming • Conflicting Emotions • Excitement and apprehension • Burst of energy/”nesting” • Difficulty making decision • High expectations

  20. Post-deployment(begins with soldier’s return) • Honeymoon period • Reunite physically but not necessarily emotionally • Loss of independence • Need for “own” space • Renegotiating routines • Reintegrating into family

  21. Children in post-deployment • Infants – may not know the soldier and cry when held • Toddlers – may be slow to warm up • Pre-schoolers – may feel guilty and scared over the separation • School age children – may want a lot of attention • Teenagers – may be moody and appear not to care

  22. Post deployment keys(avoiding the cat and mouse game) • Patient communication • Going slow • Children’s pace • Lowering expectations • Taking the time to get to know each other again

  23. Deployment Effects on Medical Assets • Parents and children feel the effects • Somatization • Emotional problems • Regression • Family Support Groups • Extended family help • Then there’s the Family Medicine Doc!

  24. Challenges for Primary Care • Screening • Anticipation, Listening for • Determining the severity • Developmental variation • Behavioral problems • Behavioral disorders • Treat or refer • Provider practice/skill, “Go-to” colleagues

  25. Consequences of Missing the Problem • Worsening condition • ADHD, school impairment • ODD, peer impairment • Conduct Disorder, negative identity formation • Antisocial Personality, societal impact • More costly/intensive treatment

  26. Barriers to Identification • Limited appointment times • Limited educational training • Inadequate access to Mental Health, others • Reimbursement problems (civilians)

  27. Behavioral Assessment Model • Environment-Behavior relationship • Family has the problem, not the child • Identifies areas for change • Parents better able to ID objective data • In contrast to psychometric testing • WARNING: Do not attempt during one appt

  28. ABC Model • Antecedent (stimulus) • Behavior (response) • Consequence (parent’s response) • Parents assigned homework ABC log

  29. Behavioral Consultation Model • Variant of ABC model • More time involvement – 3-4 appts? • Consults will contain more helpful info • Involvement of other professionals • With experience, process will quicken

  30. Behavioral Consultation Model • Problem identification • ABC model • Problem analysis • Positive reinforcement • Negative reinforcement • Plan implementation • Treatment evaluation

  31. An Example: Non-compliance • Can be considered developmentally appropriate • Adolescents and pre-schoolers • Examples: whining, yelling, tantrums, failure to complete tasks • Common cause: parental inconsistency

  32. Failure to Make Bed • Problem identification • Antecedent: Child is told to make his bed before leaving for school • Behavior: Child fails to make his bed properly • Consequence: Parent returns from work and notices after dinner, argument ensues, parent lectures, and child goes to bed ultimately without making his bed

  33. Failure to Make Bed • Problem Analysis • Positive reinforcement: Gets parent’s otherwise limited weeknight attention • Negative reinforcement: Child does not have to make bed • Plan Implementation • Parent initially makes bed with child before work • Praises and (re)teaches the “how-to’s”

  34. Failure to Make Bed • Treatment evaluation • # of times bed made right per week • # of “special times” per week • Other areas of non-compliance • Other behaviors that require change • Eating behaviors- 25-35% prevalence • Sleep behaviors- 25% prevalence

  35. Other Helpful Tools • Look child in the eye when assigning tasks • One task assignment at a time • Get a back-brief to ensure understanding • Use “Do” statements vs. “Don’t” • Catch them while they are good

  36. What do you think?

  37. Picky Eaters • Development stage • Less caloric need • Parent’s role • Child’s role • Influences www.cdc.gov: “Bright Futures”

  38. Toilet Training • “Child-Oriented” Approach (Brazelton) • Socially acceptable • Little supportive evidence • Intensive approach (Azrin and Foxx) • Unknown acceptability • Good empiric support

  39. Temper Tantrums • 18mos to 4 yrs • Window to emotions • Crying to breath-holding, head banging, to spectacular displays of dysregulation in “normal” children • Anger and Distress

  40. QUESTIONS OR COMMENTS?

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