Counselors Called for Service: Impact of Parental Deployment on Preschool Children

Abstract

Children and families often experience stress from the physical or emotional absence of a parent due to deployment. The health of the family system plays a vital role in the successful transition through deployment and redeployment phases. Even very young children show signs of behavioral problems, sleep disturbances, depressive symptoms, and anxiety from parental deployment. This article reviews the literature concerning the impact of parental deployment on preschool aged children and current interventions and discusses implications for counselors assisting military families.

Keywords

family military preschool mental health parental stress

Early childhood lays the foundation for skills that children need for life success. Competencies acquired during early childhood predict later health and well-being (Shonkoff & Phillips, 2000). The three major developmental tasks of children from birth to 5 years are building: (1) self-control and independence, (2) language, reasoning, and problem-solving skills, and (3) relationships (Shonkoff & Phillips, 2000). If this development is disrupted, children may have delayed development and less positive academic, economic, and health outcomes.

Children’s emotional health is directly related to the emotional well-being of their parents or other primary caregivers (National Scientific Council on the Developing Child [NSCDC], 2008). Research confirms the link between parental stress levels and negative parenting behaviors (Coyl, Roggman, & Newland, 2002; McNulty, 2005; Ritchie & Holden, 1998), which can increase the likelihood of behavioral problems in children (Bradley & Corwyn, 2007; Brotman et al., 2009; Gelfand, Teti, & Radin-Fox, 1992). Parental stress has been associated with increased likelihood of parent–child conflict and child maltreatment (Crnic & Acevedo, 1995; Rodgers, 1998; Rodriguez & Green, 1997). When a parent’s unavailability, poor mental health, or declining physical health disrupts the parent–child relationship, young children may develop anxiety and depression and have difficulty coping with stress and relationships (Sameroff & Fiese, 2000).

As military families face multiple and lengthy deployments, counselors must understand the negative impact stress has on the family and development of young children. Studies indicate the need to support healthy Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) family functioning (Evans, Cowlishaw, Forbes, Parslow & Lewis, 2010; Foran, Smith-Slep, & Heyman, 2011; Gewirtz, Pulusny, DeGarmo, Khaylis, & Erbes, 2010), but most studies and interventions focus on families with older children. This is a disparity, given that the majority of families with at least one deployed parent have young children (Paris, DeVoe, Ross, & Acker, 2010). This article reviews the literature concerning the impact of combat-related parental deployment on the mental health and behaviors of preschool aged children, describes interventions, and discusses the implications for counselors and the counseling profession. We analyzed peer-reviewed articles published in English between March 1989 and May 2011 in journals and on such websites as the Defense Technical Information Center, Military Family Research Institute, and the RAND Corporation. Thirty-two articles described the social, emotional, or behavioral impact of parental deployment on preschool children and related interventions. Table 1 lists the articles reviewed.

Table 1.

Articles Examined

Author, Yr	Method	Measures	Sampling	Population	Age	Focus
Blount et al., 1992	Descriptive	NA	NA	Children	Young Children	Behavior
Baker & Berry, 2009	Quantitative	Survey	Convenience	Families	0-18	Behavior
Briggs & Atkinson, 2006	Descriptive	NA	NA	Army Families	N/A	Intervention
Chamberlain et al., 2003	Descriptive	NA	NA			NA
Chartrand et al., 2009	Cross-Sectional	CBCL	Convenience	Marine Children	1 1/2-5	Behavior
Daly & Grieger, 2002	Case study	NA	NA	Child	4	Behavior
Department of Defense, 2009	Quantitative	Survey	Convenience	Military Families	0–18	Behavior
Eide & Hisle-Gorman, 2010	Quantitative	Record Review	Convenience	Military Families	<2	Child Visits
Fallon & Russo, 2003	Secondary Analysis	Questionnaire	Stratified	Military Parents	Young Children
Flake et al., 2009	Quantitative	PSC, PSI-SF, PSS	Convenience	Army Spouses w/Children	5–12	Psychosocial Profile
Fitzsimons & Krause-Parello, 2009	Descriptive	NA	NA	Military Families	0–18	Deployment
Gibbs et al., 2007	Quantitative	Database	Convenience	Army Families	All	Abuse
Grabert 2009	Descriptive	NA	NA	Army Families	0–3	Intervention
Jellen et al., 2001	Quantitative	Record review	Convenience	Army Families	All	Abuse
Jensen et al., 1996	Quantitative	CBCL, CDI, CES-D, etc	Convenience	Families	4–7	Deployed vs. non
Kelley 1994	Quantitative	CBCL, PDI, PSI, MSAS, EFS	Convenience	118 Navy Mothers	5–13	Deployed vs. non
Kelley et al., 2001	Quantitative	CBCL	Convenience	Navy Mothers	4–18	Behavior
Lamberg, 2009	Descriptive	NA	NA	Families	NA	Deployment
Leach et al., 1993	Quantitative	Questionnaire	Convenience	Military Families	All	Medical Consultation
Lemmon & Chartrand 2009	Descriptive	NA	NA	Military Youth	0–18	Support
Levai et al., 1994	Quantitative	Record review	Convenience	Navy Children	Child/Adol	Psychiatric Tx
Levai et al., 1995	Quantitative	Record review	Convenience	Navy Children	Child/Adol	Psychiatric
Lucas et al., 2002	Quantitative	Record review	Convenience	Air Force Families	4–18	Abuse
McCarroll et al., 2009	Quantitative	Database	Convenience	Families	0–18	Abuse
McFarlane 2009	Descriptive	NA	NA	Families	0–18	Interventions
Paris et al., 2010	Descriptive	Lit Review	NA	Military Childrenes	Young Children	Impact
Rabb et al., 1993	Descriptive	NA	NA	Army Famili		Intervention
Raiha & Soma 1997	Quantitative	Secondary Analysis	Convenience	Army Families	0–17	Abuse
Rentz et al., 2007	Quantitative	Database	Comparison	Active Duty & Civilian	0–17	Abuse
Rentz et al., 2008	Quantitative	Database	Comparison	Active Duty & Civilian	0–17	Abuse
Rosen et al., 1993	Quantitative	Questionnaire	Convenience	Army Families	0–18	Behavior
Russo & Fallon, 2001	Secondary Analysis	Questionnaire	Stratified	Families	0–6	Stress
Zeff et al., 1997	Qualitative	CBCL, SCL-90-R, LER, IPBI, RADS; RCDS	Convenience	Army Families	4–18	Child Behavior

Note. CBCL, Child Behavior Checklist; CDI, Child Depression Inventory; CES-D, Center for Epidemiologic Studies-Depression scale; FES, Family Environment scale; IPBI, Iowa Parent Behavior Inventory; LER, life events record; MSAS, Maternal Separation Anxiety scale; PCS, Preschool Competence scale; PDI, Parenting Dimensions Inventory; PSC, Pediatric Symptom Checklist; PSI-SF, Parent Stress Index—Short Form; PSS, Perceived Stress scale; RADS, Reynolds Adolescent Depression scale; RCDS, Reynolds Child Depression scale; SCL-90-R, 90 Item Self-Report Symptom Inventory.

Resilience to Stress

The majority of families have the skills to cope with deployment, but some are unable to handle the stress without negative consequences (Chandra et al., 2010; McNulty, 2005). Individuals that have learned to be resilient draw upon their internal resources and support in their environment to endure hardship (Weiss, Coll, Gerbauer, Smiley, & Carillo, 2010). Children learn these coping skills through the development of cognitive thinking, regulation of behavior, and interactions with caregivers and the environment (Masten, 2001). Young children in stressed families may not adequately learn these coping behaviors and, therefore, risk long-term physical and mental health problems due to the effects of stress on the developing body and brain (NSCDC, 2008). As military families are faced with continued stressors from deployment and redeployment, they may seek assistance from mental health professionals. Counselors providing service to these family members must be informed about military life. This includes understanding the distinct ethics, codes of conduct, and strict hierarchical roles of the culture. Counselors must become equipped with knowledge and interventions (Weiss et al., 2010) suited for all family members including those under the age of six.

Internalizing and Externalizing Behaviors Identified in Young Children

Previous studies indicate that some children whose parents were deployed experienced school phobia, poor grades, oppositional defiant disorder, attention difficulties, sleep disturbances, eating problems, aggression, and attachment problems (Baker & Berry 2009; Blount, Curry, & Lubin, 1992; Chartrand, Frank, White, & Shope, 2008; Daly & Grieger, 2002; Rosen, Teitelbaum, & Westhuis, 1993). Boys displayed more symptoms of distress, behavior problems, and difficulties in school, while girls exhibited more internalizing behaviors such as sadness and withdrawal (Jensen, Martin, & Watanabe, 1996; Levai, Kaplan, Daly, & McIntosh, 1994; Rosen et al., 1993).

Families of veterans deployed to operation desert storm indicated that their children’s behavioral problems were present but not severe enough to seek mental health counseling (Rosen et al., 1993). A recent study of active-duty military families found that when a parent was deployed, 60% of parents reported that their children had increased fear and anxiety, 23% reported that a child coped poorly, and 36% indicated that the child’s grades and school behavior suffered (Department of Defense [DoD], 2009). These findings are consistent with research that children of deployed parents may experience increased anxiety and sadness (Jensen et al., 1996; Rosen et al., 1993) and be at risk of psychiatric hospitalization (Levai, Kaplan, Ackermann, & Hammock, 1995).

In a study of 233 children who were aged 1.5 to 5 years and had a parent in the Marines, children with a deployed parent exhibited increased negative behavior when compared to peers without a deployed parent (Chartrand et al., 2008). Negative behaviors included higher internalizing symptoms such as sadness and externalizing symptoms such as aggression. Similarly, Kelley et al. (2001) found that young children of deployed Navy mothers exhibited significantly higher levels of internalizing behavior than children of nondeployed mothers and slightly higher levels of both internalizing and externalizing behavior than children of civilian mothers.

Parental stress can affect the parent’s ability to provide nurturance, which may in turn lead to negative child behaviors. Nondeployed parents lack the support of a spouse or partner, have changes in responsibilities, and experience decreased financial stability (McFarlane, 2009). In a study of child behavior, family stress, and parenting practices in Army families with parental deployment anticipated within 1 month, the nondeploying spouse was more distressed than the deploying parent. Further, the nondeploying parent displayed low levels of nurturing behaviors when the child’s acting-out behavior was at its worst (McFarlane, 2009; Zeff, Lewis, & Hirsch, 1997). Fitzsimons and Krausse-Parello (2009) reported that families experience less nurturance and cohesiveness and more behavioral disruptions from the children after a parent was deployed. McFarlane (2009) found that after deployment, the nondeployed parent has diminished coping resources and may need to emotionally detach, change roles, and take different responsibilities.

Risk Factors

Several factors lead to poor adjustment in children and families experiencing parental deployment. The cumulative risk theory asserts that the number of risk factors a child experiences in early childhood predicts behavior problems in adolescence. Evidence substantiates a linear model of cumulative risk: the more risks present, the worse the child’s social and emotional health (Appleyard, Egeland, van Dulmen, & Sroufe, 2005). Risk factors in military families include poor adaptability, limited family support or family conflict, parent’s military rank, financial instability, parents’ age and maturity level, parental alcohol or drug use, ages and number of children, children with disabilities, cumulative months of deployment, and the mental health of the parents (Blount et al., 1992; Briggs & Atkinson, 2006; Chamberlain, Stander, & Merrill, 2003; Chandra et al., 2010; Fallon & Russo, 2003). Significant predictors of impaired child psychosocial functioning are high parental stress, frequent moves (Baker & Berry, 2009) and parental separation (Kelley, 1994)

Parental mental health is a key risk factor. One indicator of parental stress is measured by the frequency with which parents seek medical attention for their children and themselves (Eide & Hisle-Gorman, 2010; Leach, Ridsdale, & Smeeton, 1993). Recently, Eide and Hisle-Gorman (2010) reported that for children aged 3–8 years, visits to the doctor for mental health issues increased 11%, behavior disorders increased 19%, and stress disorders 18% after a parent deployed. Researchers at a military hospital practice in England examined the relationship between a mother’s mental state and the likelihood of seeking medical attention for herself or her child (Leach et al., 1993). They found that the number of times a mother sought medical attention for her child was influenced by her psychological state, her own consultation rate, and the number of children in the family. They concluded that identifying and managing the mother’s symptoms may improve her health and that of her family.

Without assistance, parents are at risk of harming their children. Although previous research indicated that the rate of reported child abuse in military families was lower than in civilian populations (Raiha & Soma, 1997). Rentz et al. (2007) found that substantiated cases of child maltreatment in military families began to rise in 2002 after the wars began. Child maltreatment in army-enlisted families was greater when soldiers were on combat-related assignments (Gibbs, Martin, Kupper, & Johnson, 2007). Rentz et al. (2008) reported that female, African American, and young (<aged 4) children were most at risk of maltreatment. Similarly, McCarroll, Ursano, Fan, and Newby (2004) found infants and young children of lower ranking parents were at greatest risk of major physical abuse and neglect. Elementary-aged boys were more at risk of physical abuse than girls, but girls of all ages were more at risk of sexual abuse. Emotional abuse (26%) was the most common with children witnessing spousal abuse in 60% of emotional abuse cases (Jellen, McCarroll, & Thayer, 2001). The nondeployed parent was usually the perpetrator (Rentz et al., 2008).

Severe cases of child abuse and neglect have led to fatalities in military families. Lucas et al. (2002) reviewed fatal abuse cases of children from families in the U.S. Air Force. One fourth had documented previous physical injuries requiring medical attention. More victims were male. The mean age at death was 3.9 years. Victims were more likely to have divorced, separated, or single parents. The majority of the deaths occurred at home, on the weekend, and after some family disturbance. Perpetrators were most often the father or father figure. In the majority of cases, the family had experienced significant life stressors such as divorce or economic hardship in the month before the homicide.

Unlike the Vietnam War, which drafted soldiers, the current wars are using an all-volunteer U.S. military, including National Guard and Reserve forces, with repeated and extended deployments, further complicating the stress on them and their families. Reactions to deployment and separation from family may vary between active-duty soldiers and reservists (Lemmon & Chartrand, 2009). Active-duty families have more connection to the military community and available services. Because reservists are not associated with a military base but live throughout their states and meet only for weekend drills, reservist families often rely on their local civilian community for support (Lamberg, 2008).

The sophistication of telecommunication systems has enabled military families to frequently and regularly communicate with deployed parents. While many may consider this access a benefit, it brings the war directly into the homes of the military family. These factors increase the need for a comprehensive assessment of the impact of these conflicts on military families. Counselors trained to understand the transitions and stressors of military family members and the impact of these challenges on the family system could assist in building cohesion and resilience.

Strengthening Resilience in Military Families

Although the literature on interventions to assist military families through the cycles of deployment is limited, researchers agree that support for the individual, family, and community is vital (Baker & Berry, 2009; Flake, Davis, Johnson, & Middleton, 2009; Fitzsimons & Krause-Parello, 2009; Lemmon & Chartrand, 2009). Importantly, community-based interventions targeting the family may have an advantage to the Veteran because it is less stigmatizing for the family to receive interventions than for the Veteran to be identified as the patient (McFarlane, 2009). One intervention for operation desert storm army reservists and their families used a family approach to improve cumulative stressors (Rabb, Baumer, & Wieseler, 1993) during predeployment, deployment, and reunification using counseling, support groups, education, and telephone outreach. There were was no formal evaluation, but anecdotal reports suggested the intervention enhanced overall functioning.

Fallon and Russo (2003) advocated family inclusion in education, counseling, and support and suggested that “family adaptation is facilitated when available resources balance the demands of the family” (p. 197). Counselors can ensure availability of resources in their communities. “Military families clearly need family-centered services and community partnerships linked to other families with similar problems” (Russo & Fallon, 2001, p. 7). Play therapy, support groups, individual and family counseling, and education have assisted military family members in all phases of deployment, but formal evaluations, specifically those for preschoolers, have been lacking (Daly & Grieger, 2002; McFarlane, 2009; Rabb et al., 1993).

Few studies report findings on the effectiveness of interventions for OEF/OIF families based on rigorous research methodology. However, researchers indicate that early interventions should target the family to develop coping skills (Applewhite & Mays, 1996; Chartrand et al., 2008; Jensen et al., 1996; Kelley, 1994; Lamberg, 2008). Many parents of young children, not just military parents, struggle to cope with their children’s challenging behaviors. In the civilian population, if there is no intervention, these early behaviors become mild-to-moderate problems in 10–15% of children, with higher rates among minority children (Egger & Angold, 2006; kennan & Wakschlag, 2000).

Two cognitive–behavioral interventions are trauma-focused cognitive behavioral therapy (TFCBT) and parent–child Interaction therapy (PCIT; Paris et al., 2010). The TFCBT techniques, such as relaxation, relationship building, and reframing, can decrease anxiety, and both child and parent can use it. PCIT facilitates positive parent–child relationships by improving social skills, increasing consistency, and assisting in behavior management (Paris et al., 2010). These interventions may prove beneficial for this young population.

Implications for Counselors

The mental health of children under the age of six has gained increased attention from mental health researchers and policy makers over the past couple of decades. Counselors working with Veterans should inquire about the family system and consider young children when conducting assessments and developing treatment plans. Counselors can assist in detecting early warning signs of stress and mental illness. Young children display anxiety and depression through introverted and extroverted behaviors that counselors may not recognize without training. Parents may need assistance to understand that children may display disruptive behaviors that seem defiant when children are anxious or depressed or reacting to the parent’s emotional state.

Discussion

Preschool aged children from Reservist/National Guard families living in rural areas are at higher risk of for social and emotional distress, and these concerns may not be identified and treated as needed. Counselors often receive limited formal education concerning the mental health of preschool aged children. Couple that with the need for additional knowledge about the mental health concerns of military families and the stigma of seeking help for mental health problems, military families with preschool aged children may not receive the needed mental health care. Counselors must not only be abreast of early childhood development and mental health but also have an understanding of family systems and how the ongoing war and multiple deployments impact all family members.

The articles reviewed indicated that the majority of military families are able to cope with combat-related military deployment, but resilience is decreased as the duration and number of deployments cumulates (Chandra et al., 2010). Researchers identified the importance of education and support throughout the deployment phases. This responsibility falls not only on the Department of Defense (DoD) and Department of Veterans Affairs (VA) but also on the communities in which these families reside. Awareness and collaboration are needed between civilians, helping professionals, and community agencies to identify the needs of these family members and reduce the stigma of seeking help for mental health problems.

To gain control over the negative mental health effect of multiple deployments, counselors and clinical researchers must determine how to provide support services within communities. Investigating potential collaborative partnerships is essential to reach active duty, National Guard, and Reserve families who are scattered throughout communities in all states. Counselors can serve as access points through which they can refer military families to appropriate programs and services.

As the mental health needs of military personnel and their family members are identified so will the need for additional mental health providers. Without increasing mental health providers, the DoD and VA health care systems may become overwhelmed (Lambert & Morgan, 2009). The VA has initiated the hiring of licensed counselors and established policies and procedures for employment, and it is essential that counselors and counselor supervisors prepare themselves to work with couples, families, and individuals experiencing combat-related deployment (Lambert & Morgan, 2009).

Additionally, the majority of returning OEF/OIF Veterans reside in rural areas (U.S. Department of Veterans Affairs, 2011), and services are not as easily accessible. Veterans and family members without access to VA services or those who choose not to use VA or DoD services may call upon community counselors for assistance. These clinicians may benefit from collaboration with the National Center for PTSD, the DoD, and the VA for additional training and information (Lambert & Morgan, 2009). Counselors, as civilians and professionals, working with military families should seek to become a positive community connection by proactively building community support (Davis, Ward, & Storm, 2011). One possible way for mental health counselors to proactively assist military families is to collaborate with school counselors in their communities.

Many families with children turn to school professionals during times of distress. Collaboration will assist in making appropriate mental health referrals. School counselors, like mental health counselors, should be well versed in the needs of and resources for military families (Harrison & Vannest, 2008; Sippola, Blumenshine, Tubesing, & Yancy, 2009). Some educational systems, such as public schools, and public early childhood education programs, such as Head Start, offer a supportive environment where children and parents can feel safe to identify concerns and ask for assistance. Schools and early childhood education facilities can enhance resilience for young military children because they encourage self-control, independence, language development, reasoning, problem solving, and relationship building.

In the future, combining the resources of the American Counseling Association (ACA), the DoD, and the VA could be a cost-effective way to educate counselors on how to better assist military families. In addition, expertise of other ACA divisions and affiliates could be utilized to begin an awareness campaign to help counselors realize the impact that their expertise could have on military families. It is important for faith-based counselors, career counselors, school counselors, and counselor educators to provide education and preventive services to decrease the potentially long-term and far-reaching effects that the war against terror can have on young children and families.

Ultimately, successful interventions translate into better-equipped soldiers defending our country and increasing resilience for Veterans and their families transitioning back to civilian life (Weiss, et al., 2010). Counselors have the education and skills to assist these families as well as being embedded in their communities. Proactive efforts to decrease the stigma of help seeking and creating awareness and supportive programs in communities could prevent these families and society from experiencing long-term negative effects of combat-related deployment.

Footnotes

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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