Trauma and Resilience Among Child Soldiers Around the World

Patricia Kerig, Cecilia Wainryb, Patricia K. Kerig, Cecilia Wainryb

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781317672975
• Edition: 1
• Topic: Psicología
• Subtopic: Historia y teoría en psicología

It is estimated that approximately 300, 000 children actively serve in various kinds of military groups around the world. Some of these children are forcibly conscripted through abduction or threats of violence to themselves or their families, others are coerced or manipulated into joining, and still others are more subtly compelled by circumstances that lead choosing to enlist to represent the lesser of the evils life has placed before them. No matter how they come to serve in war, however, child soldiers are exposed to, subjected to, and often forced to perpetrate horrors that meet or exceed our diagnostic criteria for trauma exposure.

This volume brings together leading investigators in the field to share new research regarding the traumatic impact of child soldiering from diverse international contexts, including Burundi, Colombia, Liberia, Mozambique, Nepal, Sierra Leone, Uganda, and—provocatively—among gang-involved youth in the United States. Contributions include data from longitudinal studies following former child soldiers into adulthood as well as investigations of the intergenerational impact of childhood conscription on former child combatants own children. In addition, research presented in this volume uncovers sources of resilience among these youth and details efforts to bring trauma-informed intervention and rehabilitation programs to these war-torn regions.

This book was originally published as a special issue of the Journal of Aggression, Maltreatment and Trauma.

Part 1
New Research on Trauma, Psychopathology and Resilience among Child Soldiers around the World

Introduction

New Research on Trauma, Psychopathology, and Resilience among Child Soldiers around the World

PATRICIA K. KERIG and CECILIA WAINRYB
Department of Psychology, University of Utah, Salt Lake City, Utah, USA

The need to understand and respond to the traumatic aftermath of war has a long and important history in the literature on post-traumatic stress disorder (PTSD). In fact, recognition of trauma among soldiers was a major catalyst for the introduction of the PTSD diagnosis in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 1980; Kulka et al., 1990; Trimble, 1985). As originally conceived, the disorder was viewed as arising from catastrophic events that were “outside the range of normal human experience,” a category in which war quite rightly might be considered to belong. Furthermore, direct involvement in warfare might quite rightly be assumed to be the purview of adults. However, for all too many children living in societies torn by political strife, civil unrest, paramilitary insurgencies, interethnic conflict, or drug cartel and gang violence, warfare is the only experience they have ever known. Moreover, for many children living in these societies, their experience of war-related violence is not limited to that of witnessing. It is estimated that approximately 300,000 children actively serve in various kinds of military groups around the world (Coalition to Stop the Use of Child Soldiers, 2008). Some of these children are forcibly conscripted through abduction or threats of violence to themselves or their families, others are coerced or manipulated into joining, and still others are more subtly compelled by circumstances that lead choosing to enlist to represent the lesser of the evils life has placed before them (Wainryb & Kerig, 2013; Wessells, 2006). No matter how they come to serve in war, however, child soldiers are exposed to, subjected to, and often forced to participate in horrors that meet or exceed our diagnostic criteria for trauma exposure (e.g., Betancourt, Agnew-Blais, Gilman, Williams, & Ellis, 2010; Betancourt, Simmons, et al., 2008; Derluyn, Broekaert, Schuyten, & De Temmerman, 2004; Derluyn, Vindevogel, & De Haene, 2013; Klasen, Gehrke, Metzner, Blotevogel, & Okello, this issue; Klasen et al., 2010; Morley & Kohrt, this issue).

Clearly, therefore, research has established that child soldiering is a significant problem with important implications for the development of psychopathology among these youth (Betancourt et al., 2013; Blattman & Annan, 2010). Moreover, considering the large number who are of child-bearing age during their conscription, or who return to their communities to raise families of their own, the experience of child soldiering has significant implications for the next generation to come (Boothby & Thomson, this issue; Song, de Jong, O’Hara, & Koopman, this issue). However, to date, despite the rich literature available regarding the short- and long-term effects of war-related experiences on adult military personnel, the problem of child soldiering has only recently emerged into the forefront and received the empirical and clinical attention it deserves. With this in mind, this two-part special issue was inspired by the desire to bring together contributors who represent some of the leading investigators in the study of child soldiers to present their cutting-edge research regarding the developmental traumatology of childhood military service. Moreover, the articles included in these two issues are international in scope and represent widely divergent geographical locations: Burundi (Song et al., this issue), Liberia (Veale, McKay, Worthen, & Wessells, 2013); Mozambique (Boothby & Thomson, this issue), Nepal (Morley & Kohrt, this issue), Sierra Leone (Borisova, Betancourt, & Willett, 2013; Veale et al., 2013), Uganda (Annan, Green, & Brier, 2013; Klasen et al., this issue; Veale et al., 2013), and, provocatively, the United States (Kerig, Wainryb, Twali, & Chaplo, this issue).

In this first part of the series, each article focuses on understanding a unique dimension of trauma exposure among child soldiers: the range of PTSD symptom expression (Klasen et al., this issue); risk and protective factors, such as peer support and hope (Morley & Kohrt, this issue); longer term implications of childhood conscription for adult functioning among men (Boothby & Thomson, this issue) and women (Song et al., this issue); and parallels between child participation in armed groups in military and civil contexts (Kerig et al., this issue). Leading off the issue, Klasen and colleagues address an important and timely subject in the study of childhood trauma, which concerns diversity in the range of traumatic experiences undergone and the consequent range of post-traumatic symptom expression. As originally suggested by Terr (1991), the original construction of the PTSD diagnosis was predicated on the assumption that trauma comprises an unusual experience interrupting an otherwise ordinary life—the “short, sharp shock to the system” (Kerig, Ward, Vanderzee, & Arnzen Moeddel, 2009, p. 1216) of a sudden accident, disaster, or violent encounter. In contrast, a second class of traumatic events is comprised of those longstanding, pervasive, interpersonal traumas that characterize the lives of those enduring ongoing adversity, such as children growing up in a maltreating environment. As further developed by Herman (1992), the term complex PTSD has come to be applied to the pervasive and insidious set of symptoms that arise in the aftermath of that second type of trauma and reflect profound disruptions in biological, emotional, cognitive, and interpersonal functioning (Ford & Courtois, 2009). As knowledge of the developmental psychopathology underlying the unique and significant impact of such pervasive traumas has accumulated, leading investigators in the field have proposed a new diagnostic category to capture them, termed Developmental Trauma Disorder (DTD; van der Kolk et al., 2009; van der Kolk, Roth, Pelcovitz, Sunday, & Spinazzola, 2005). The proposal that DTD be included as a new diagnostic category in the DSM-5 was accompanied by a growing body of research supporting the argument that exposure to repeated, pervasive interpersonal traumas during childhood has profoundly different effects on the developing body and mind than does exposure to the “simple” traumas that the original PTSD criteria were designed to capture (D’Andrea, Ford, Stolbach, Spinazzola, & van der Kolk, 2012). Moreover, as Freyd (1996) suggested, and research has confirmed (e.g., Kerig, Bennett, Thompson, & Becker, 2012; Martin, Cromer, DePrince, & Freyd, 2011), harm that is perpetrated at the hands of a person on whom the victim should be able to rely for nurturance and care constitutes a betrayal of trust that further undermines psychological and interpersonal functioning. Thus, for children, intentional maltreatment by parents, caregivers, or adult authority figures will have more profound implications than would negative experiences that are accidental or at the hands of strangers. Although ultimately the proposal for a new diagnostic category was not accepted, and DTD is not included in the new fifth edition of the DSM (Resick et al., 2012), the construct continues to inspire an important research literature that speaks to its validity and clinical utility (Silvern & Griese, 2013; Stolbach et al., in press).

With this research in mind, Klasen and colleagues perceptively propose that Ugandan child soldiers might fit the profile of the complexly traumatized child: Their traumatic experiences not only have been repeated and pervasive, but they have involved interpersonal assaults, both suffered and perpetrated, at the behest of the adults on whom these youth should have been able to rely for nurturance and guidance (Klasen et al., 2010). Their research involved a sample of 330 children abducted and forcibly conscripted into combat in northern Uganda who were subsequently undergoing rehabilitation at a government school. To investigate their question, the authors used current best practices in assessing DTD through the use of multiple measures to capture this multidimensional construct, including measures assessing dysregulation of social, emotional, cognitive, physiological, and behavioral development. Their results document the severity of the victimization undergone by these children. On average, children in this sample endorsed experiencing 15 out of the 19 possible war-related traumatic experiences on the investigators’ survey, all of which occurred against a backdrop of prior exposure to domestic and community violence. Among the authors’ most striking findings is that, although only 33% of the children met criteria for the PTSD diagnosis as per DSM, suggesting the possibility of resilience among the majority of them, over 78% met criteria for DTD. Therefore, these results suggest that some of the most harmful sequelae of child soldiering could fly under the radar of assessments that adhere too closely to the DSM criteria for post-traumatic stress. Moreover, the authors investigated the question of which variables acted as the most powerful predictors of DTD, and found these to involve exposure to community violence, perceived social support, depression, and domestic violence. Interestingly, whereas certain other variables were related to PTSD, including age at abduction, length of abduction, and number of traumatic events experienced during abduction, these did not contribute to the prediction of DTD. These findings are consistent with the proposition that DTD is a discrete syndrome associated most fundamentally with “failures in the average expectable environment” (Cicchetti & Valentino, 2006, p. 129) provided by the most proximal socialization agents in a child’s life, the home and community.

The next article in this issue turns from the study of risk to the investigation of factors leading to resilience. Although a topic of longstanding interest in the field of developmental psychopathology, the construct of resilience only recently has been investigated in the context of child soldiering (Betancourt et al., 2013; Klasen et al., 2010; Masten & Narayan, 2012) and has generated a significant amount of discussion and controversy (Barber, 2013; Wessells, 2006). In particular, how are we to fairly capture the capacity for transcending diversity without unfairly downplaying the profound effects of the traumatic impact of child soldiering (Derluyn et al., 2013; Wainryb & Kerig, 2013)? In this regard, Morley and Kohrt make a valuable contribution to our thinking about resilience in their study of the interpersonal context in which returning child soldiers are embedded. In particular, they propose that the social support provided by peers plays an important role in the reintegration of child soldiers on their return to their communities, just as its lack could undermine their rehabilitation. However, in their investigation of 142 former child soldiers in Nepal, these researchers find, as is the case in many other studies of child soldiers around the world (e.g., Betancourt, Borisova, et al., 2008; Bocanegra & Stolbach, 2012; Klasen et al., this issue; Llorente, Chaux, & Salas, 2004; Miller & Decker, 2001; Moore & Hagedorn, 2001), that those conscripted as children differed from their peers even before the war in regard to the lesser extent to which they enjoyed supportive home lives and positive social relations. As the developmental psychopathology literature attests, unsupportive attachment relationships in early life increase the vulnerability of children to victimization and revictimization across the life span (Kerig, Bennett, et al., 2012), and in the same way, perhaps this underlying vulnerability, and the absence of protective caregivers, makes these youth more attractive targets to armed forces recruiters (Kerig et al., this issue). Reintegration for these youth, therefore, does not involve the return to normalcy, but rather the more difficult challenge of establishing a network of positive relationships where they had been previously absent and, moreover, doing so in the face of the stigma associated with their status as former child combatants (Betancourt, Borisova, et al., 2010; Boothby & Thomson, this issue; Borisova et al., 2013; Derluyn et al., 2004; Klasen et al., this issue; Veale et al., 2013). The pain associated with this stigma is evidenced by the research team’s earlier finding that former child soldiers reported that peer and family rejection were even more distressing to them than their wartime experiences (Kohrt, Tol, Pettigrew, & Karki, 2010). In this study, as the investigators hypothesized, peer support predicted increased hope, decreased functional impairment, and decreased levels of PTSD, whereas poor quality peer relations predicted less hope and more PTSD symptoms among youth in their sample.

An intriguing task for future research will be to attempt to unravel the threads of the transactional processes that might be at play in the associations among trauma-generated dysfunctional behaviors, stigma, negative social expectancies, peer rejection, alienation, and the exacerbation of interpersonal problems over time (Kerig & Becker, 2010; Kerig, Ludlow, & Wenar, 2012). However, as Kohrt and colleagues note, and as echoed in the narratives of adult former child soldiers reported by Boothby and Thomson (this issue) and the research on other rehabilitation programs for child soldiers (Annan et al., 2013; Borisova et al., 2013; Veale et al., 2013), reintegration efforts will be enhanced by increased attention to increasing support in the social sphere. As the authors quite rightly point out, the label “child” soldiers obscures the fact that the majority of these youth are adolescents, and knowledge of the stage-salient issues associated with the teenage years should alert us to the importance of peer relationships in any intervention designed to increase mental health and interpersonal adaptation.

Turning to the case of Mozambique, Boothby and Thomson also focus on a sample of former child soldiers who were reintegrated with their communities. However, these authors even further expand our understanding of the long-term effects of trauma by following 40 of these boys into adulthood and examining the shadow cast by their wartime experiences on their functioning as husbands, fathers, and community members. By tracking the psychological outcomes of these once boys, now men, over a period of 16 years, this ground-breaking study provides the first prospective longitudinal investigation of traumatized child soldiers into adulthood. Literally stripped—of their shirts, their families, their dignity, their identities, and, finally, their humanity—these boys were brutally resocialized to fulfill the roles of exterminators of other human beings. The adult outcomes of these rehabilitated youth highlight both continued risk as well as the potential for resilience. On the side of risk, an important observation, particularly given the ongoing debates over the cross-cultural appropriateness of the DSM diagnosis of PTSD (Fernando, 2005; Miller, Kulkami, & Kushner, 2006), is that respondents reported experiencing a culturally accepted syndrome termed npfuka. Despite the discrepancies between the culture that originated the DSM diagnostic category of PTSD and the society in which npfuka is a recognized entity, the two terms appear to capture much of the same symptom profile, including nightmares, violent outbursts, and agitation. Moreover, the classic PTSD symptom of traumatic reexperiencing seems to emerge in regard to the former child soliders’ reports of struggling to escape from feeling haunted by their pasts. Further, for boys who spent a year or more with their captors, identification with their aggressors (Frankel, 2002) appeared to compromise their ability to reintegrate successfully into civilian life. On the other side of the coin, major sources of resilience that emerge in these narratives include the men’s agency in using problem-focused coping mechanisms, such as engaging in active avoidance of trauma reminders and instrumentall...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Citation Information
• Notes on Contributors
• Part 1: New Research on Trauma, Psychopathology and Resilience among Child Soldiers around the World
• Trauma Symptom Expression Among Former Child Soldiers
• Long-Term Impacts of Involvement in Child Soldiering
• Implications of International Research on Child Soldiers for Studying Youth in the US
• Part 2: Interventions to Promote Reintegration of Traumatized Youth Conscripted as Child Soldiers
• Efforts to Promote Reintegration and Rehabilitation of Traumatized Former Child Soldiers
• Toward the Future: Implications of Research and Intervention with Traumatized Former Child Soldiers
• Index