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Are military kids okay?

Most children are coping, but some are distressed

Warning signs of stress in children vary by age, but can include anything from developmental regressions such as bedwetting in very small children to a lack of interest in formerly favorite activities. Courtesy photo

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They're strong and they're resilient. They're adaptable. They're well-travelled and fiercely patriotic. They're bright, inquisitive and eager to help out, whether that's at home or in their communities. They have advantages many kids don't: parents with jobs and steady incomes, healthcare, safe housing, good education systems and access to early intervention programs.

But they're also children, and they're navigating a new and strange world of school and sports, bullies and gossip, first boyfriends and girlfriends, and puberty and hormones. Growing up is hard. It's scary. It's easy for kids to lose their way. And life can become harder and scarier when kids have to move every three years or when their parents miss portions of their childhoods because they're regularly deployed. And it becomes twice as hard when those parents come home changed from post-traumatic stress or traumatic brain injuries.

While most military kids tend to handle one or two deployments well, and as a whole are doing great, experts say that the trouble can start with repeated, back-to-back deployments.

"Kids often experience more anxiety," said Dr. Michael Faran, a psychiatrist, retired colonel and chief of the Child, Adolescent and Family Behavioral Health Office at Army Medical Command, explaining that while there isn't a lot of data, some studies suggest about 30 percent of children will have difficulties as a result of deployment. "There's an increase in depression and anxiety. There can be a decrease in academic performance. In some adolescents, there's an increase in use of drugs and alcohol. And there has been more gang activity reported in some teens."

There have even been reports of higher levels of suicidal ideations among children who have been through numerous parental deployments, added Dr. Stephen Cozza, a retired colonel, psychiatrist, researcher, professor and associate director of the Center for the Study of Traumatic Stress at the Uniformed Services University in Bethesda, Maryland.

"That doesn't necessarily mean that military children are mentally ill, but that they're distressed," he said. "They express it in a variety of ways. The other thing that's important to recognize is that ... the majority of children are doing well despite those challenges."

Warning signs of stress in children vary by age, but can include anything from developmental regressions such as bedwetting in very small children to a lack of interest in formerly favorite activities to anger and risk-taking behavior in teenagers.

Parents should not equate good behavior with mental health, however. Faran cautioned that parents can easily overlook children who withdraw because they're quiet and they aren't causing trouble. "They may be getting very depressed or anxious, and no one is aware of it," he said. "So these kids stop talking and they used to talk to the parents. That is a red flag."

Signs of anxiety - the most common disorder in military children - also include separation anxiety, fears for the health of the parent left at home, excessive worry, sleep problems and frequent physical complaints such as headaches or stomachaches.

Maisley Paxton, a child clinical psychologist at Fort Meade, Maryland, said that while parents should expect to see some changes in their children in the period immediately after a permanent change of station move or a deployment or even a homecoming, they shouldn't let any pronounced differences persist for long before seeking help. Paxton also recommended that children be evaluated by their pediatricians, especially if they're experiencing those frequent aches and pains.

Any child who self harms, threatens to kill herself or says he wishes he was dead, needs immediate help.

"People always think that it's a phase," Paxton said, adding this attitude is especially common in military families. It's all too easy to blame the current duty station or the local school and teachers for a child's behavior or sudden poor grades, and just hope that things will be different after the next move. Occasionally, that's a valid belief. "However, the news that parents need to have is that the earlier they get the intervention, the earlier they get the treatment, the better the prognosis and the better the outcome."

"I think it's important for a lot of parents to recognize that kids don't always use the same words and terminology that we do," said retired Lt. Col. Patti Johnson, psychologist and Faran's deputy chief at CAFBHO. She explained that many children express their emotions differently than parents might expect - depression often manifests itself as anger in teenagers, for example. She urged parents to see their children's mental health as every bit as important as their physical health, and to readily seek care just like they would for a medical illness.

"Parents think it will go away," added Faran, "and then by the time they're teenagers, it can be a big issue." He explained that the Army is rolling out the Child and Family Behavioral Health System to better connect family members with top-notch mental healthcare. It includes traditional behavioral healthcare, but also integrates care into primary care clinics and schools, the places issues are often first identified in children and teens. Elements of CAFBHS are currently at 20 installations, including at Madigan Army Medical Center, and will be implemented Army wide by 2017. "The CAFBHS is a collaborative program with the Army medical homes, working with the primary care folks ... to ensure that our kids are first identified if they are having problems, and then that they're getting services they need. ... Once it's out there, it's going to reach more Army youth than we have in the past."

Many of the issues practitioners see in military kids - attention deficit hyperactivity disorder, depression, mood disorders and personality issues - may have little or nothing to do with their military upbringings, the experts stressed. Most of the time, the same kids would have the same issues in the civilian world. With a little professional help, the majority will be fine.

It's the children of parents who return from war with their own wounds, with PTSD, with depression, with TBIs, who most concern experts because "those kinds of incidents tend to be highly disruptive to families," said Cozza. "There's less structure. There's more chaos. There are more immediate needs. ... There's a lot of upheaval in families. Parents may be preoccupied in dealing with the injury so we need to help them draw their attention back to their children."

Editorial note: Part two of this story will appear next week.

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