Children in transition and crisis (chapter in collective volume)

Foreword

ln July 1991 Prof. Solly Dreman, a clinical psychologist from the Ben-CurionUniversity of the Negev, Beer-Shev4 lsrael, was a Buest of the HSRC Research

Programme on Marriage and Family Life, and inter alia led a seminar on childrenand families. He read the introductory paper at this seminar and subsequentlywrote the concluding paper in which he discussed the nine other Paperspresented at the seminar, in the light of current theory on children and families.

All 11 of these papers have been revised and constitute the contents of thispublication.

As its number indicates, this publication is the ninth in the series of publicationsunder the Co-operative Programme on Marriage and Family Life. The

Programme was established in 1986 and its management committee has

approved just more than 30 research projeas to date. The projects that havebeen completed and published as reports cover inter alia such broad subjectsas family policy and family structures as well as more circumscribed subjecssuch as the children of divorce, domestic violence and family therapy.

Through the reports, the research results emanating from our projects aredisseminated and we believe that the working pape6 with their bird's eye viewof a number of these projects, will be a useful publication for sociologists andothers in social science fields.

Dr Ina Snyman

Manager: HSRC R.esearch Programmeon Marriage and Family Life

Children in tansition and crbis

I Clildren in tronsition M crisis

Solly Dreman

Abstract

This paper examines children's coping and adjustment in the face of transitionor crisis from an interactional point of view. Neither individual characteristics,nor interpersonal or situational factors, are sufficient to explain children's long-term adjustmenl lt is rather the interaction between individual characteristicstogether with changing interpersonal and situational influences which arenecessary to understand coping and adjustment over time. Research andclinical observations are presented to support this thesis.

IntroductionIn our examination of children's adjustment we will present an interactionalmodel which views adjustment as occurring within a framework of multiplefeedback mechanisms between the individual and interpersonal and situationalfactors. This is in contrast to models of family patholory (e.g. Haley, 1972 whichview individual psychopathology as resuking mainly from disturbed externalfactors of an interpersonal nature, or models of trauma which view traumaticreactions to be tfthe result of an external event with no characteristicpopulation and few identifiable risk factorstt (see Martini et a1.,1990:75). lt alsodiffers from intrapsychic rnodels such as psychoanalytic theory (e.g. Freud,1936) which perceive disturbed behaviour as a residue of unresolvedunconscious conflicts within the individual. We, on the other hand, proposethat adjustment is a dynamic process which involves an ongoing interplay ofintrapersonal, interpersonal and situational components or frnested contextsfrBronfenbrenner, 197q. The present paper attempts to examine human

Children in ransroon atil ciss

reactions to traumatic, para-normative and predictable life cycle events using

this interactional model as an explanatory framework.

ln traumatic frman-madeff events such as war, terrorism, kidnapping and

parental homicide, or traumatic ttacts of godrt such as floods and earthquakes,dramatic environmental contingencies may negatively influence short-termadjustmen! precipitating shock, disorientation, state-anxiety and denial(Dreman, 1991; Eth & Pynoos, 1985; Terr, 1981; 1983). These reactions are

referred to as post-traumatic stress disorders (PTSD). Figley (1983; 1985)

distinguishes between the passive ftvictimtr initially immobilized by traumaticexternal events versus the rrsurvivorrf who, after recovering from the initialshock, copes more actively with his environment and the new post-traumaticrealities. Such long-term adjustment is affected by a variety of intrapersonal,interpersonal and situational factors which occur after the actual traumaticevents and also by events related to the victim's history prior to the trauma-lnfluencing such pre- and post-traumatic coping are individual factors such as

premorbid personality, previous experience in dealing with trauma and copingstyles of the victim, interpersonal factors such as available family supportsystems, and situational factors such as recurring incidents of trauma-relatedevents.

The interactional model is also applicable to coping and adjustment in the faceof frpara-normative eventsft (ferkelson, 1980) like divorce, illness and otherunexpected events which a family may experience. lt is also relevant to theexamination of more predictable life cycle transitions such as the birth of achild, adolescence, marriage and the frempty nestrf which all requireconsiderable change in attitudes, roles and behaviour amongst familymembers in order to move successfully from one developmental stage tothe next (Carter & McColdrick, 1988).

2

Chlldren ln u'ansition atrd crlsls

A. Traumatic eyents

1. Traumatic physical injury

some proof of the interactional contention is offered in a study of PTSD(Martini et al., 1990) concerning a regatta accidenl The Pittsburgh Regatta is afour-day long event that highlights several activities on the ciqy's three rivers. tna speedboat race in August 1988 a boat buffeted by the wind and choppywater suddenly veered into the crowd. Twenty-three people were injured in theaccident, 12 of whom were children. Eight of these children were transportedto the Children's Hospital of Pittsburgh. Six of the families concerned werecontacted and agreed to participate in the study two months after theaccident. The primary goal of this psychiatric/psychosocial evaluation was toobtain immediate post-injury information on the children's recollection of theaccident and their reaction to it as well as their current level of stress andadjustment to the injury. A parent and the child victim were each interviewedand a number of tests measuring adjustmeng including tests of affectivedisorders and PTSD, were applied.

Martini et aL (1990) noted that PTSD has been considered by some to be theresult of external events with no characteristic population and few identifiablerisk factors. This contention is in accordance with the dictates of theinterPersonal/situational model which stresses externa! events and places littleemphasis on individual/intrapersonalfactors. The variability in the responses tothe regatta accident, however, leads to a more complo< multidimensionalapproach to the problem. Arguing against the ffexternal eventfr thesis was thefinding that the presence of PTSD was not related to the nature or the ortent ofthe injury itself (n this case a physical traumd, but was found to be a result ofadditional individual, interpersonal and situational factors, like a child's positivepsychiatric history available coping styles in the patient and family, the level offamily stress, and experience in effectively dealing with stressful episodes in thepast.

To illustrate: The child with the highest level of PTSD suffered minimal physicaldistress and little change in his lifestyle as a resutt of the acciden! arguingagainst the external events model of post-traumatic symptomatology.

Ciildra in r:zrlsition atrrd cisis

However, this child was located in a family that had underSone several recent

transitions leading to less time spent by the parents in the home, higher levels

of conflict, less family cohesion, and a lack of effective parental limit setting

and control. Another child, with slight injury, who demonstrated severe PTSD

symptomatology, had been diagnosed as autistic when younSer, as well .as

being recentfliagnosed as having an attention deficit disorder (ADHD)' The

above interpersoniland intraPersonal deficits resuhed in a mild physical injury

culminating in a severe Post+raumatic disorder, and suPPort an interactional

view which considers other intrapersonal and interpersonal and situational

factors, besides the traumatic events themselves, as playing a major part in the

post-traumatic sympto matologY.

Further support for the interactional model was the finding that other children

recovered-well, even when physical injury was severe, if the family mobilized its

resources and took an active and constructive approach to the trauma This

finding is supported by research showing that the child who witnesses an

appropriate response in the family is better able to tolerate the immediate and

more long-term effects of trauma (Frederick, 1985).

ln summary these researchers sugSest that the development of PTSD.in

children shoutd begin with a consideration of the emotional makeuP of the

child and the family, with the severity of the trauma evaluated in that context

Such an interactional approach is more likely to predict post-traumatic

adjustment than an exclusively individual or external events model of post-

traumatic adjustment. There may be a subset of children with varying

psychiatric diagnoses or having certain behavioural tendencies that are likely

io'develop PTSb when involved in even mild forms of Uaum4 whereas other

children may not develop such disorders even when trauma is severe if they

have strong personal coping resources and/or a supportive interpersonal

network.

2. Acts ol terrorism

A ten-year follow-up of children whose parents were killed in terrorist activities

in tsraet suggests ihat changing intrapersonal, interpersonal and situational

Childra tn tansltion and crlsls

factors affect recovery from PTSD (Dreman, 1989; Dreman & Cohen, 1990). Onthe individual level it was shown that children were often plagued byunresolved unconscious issues relating to the original traumatic events whichprecipitated feelings of helplessness and loss of control. This expressed itself inacting out and delinquent behaviours which served a particular psychologicalneed:

a Such behaviour gave them some control over their ltdangerousft

environment Being exposed to traumatic events may cause children toexperience ongoing largely unconscious, feelings of loss of control andhelplessness throughout their life if these feelingp have not been ffworked

throughfr. This may result in compensative behaviour designed to restorefeelings of control over an otherwise unpredictable environmenl For

examplg one child stole money from his stepfather even though this wasunnecessary since this parental figure was very generous and always leftspending money for him on the table. lt was contended that stealinghelped the child to rrcontrol the purse stringprf and hence gain control ofhis unpredictable environmenL

b. It helped these children expiate guilt related to the traumatic events. For

example, they often engaged in petty robberies and other minor crimes,committed in an amateurish fashion, almost as if wishing to be caught. ltw.rs suggested that these acts, by inviting punishment permit e:<piation offfsurvival guiltrr related to the terrorist incidents in which their parents hadbeen killed.

c. Another characteristic of these children was their need for instant impulsegratification and compensation for their earlier losses. These children oftenmarry earlier because of their need to replace the loved ones lost intraumatic events, or engage in delinquent behaviours such as stealing tocompensate for their earlier interpersonal losses. This is vividly illustratedby one chitd who proudly proclaimed: ftl do what is good for me andnobody tells me what to dotfr Paradoxically, this child's need for instantgratification and control has resulted in loss of contro! and deficis in his

interpersonal relations and attainment of job skills.

Children in r,ansition and cririt

These children displayed other behaviours which also reflected a need to deawith archaic feelings of loss of control related to the original trauma Theseincluded re'enactment behaviour where children rehearse the traumaticevents repeatedly. To illustrate: Two brothers, whose parents were killed blterrorists who boarded a passenger bus and murdered its passengers in coloblood, continually rehearsed escape procedures by climbing out of a bathroornwindow in a ritualistic fashion. A narrowed time perspective, includinepessimism about the future, was arso typical of these children. For example, achild whose father was killed by an explosive planted by a terroristcommented on his

_siste/s h"ppy disposition by noiing: frtf you are happrnow you'll only be disappointed in the future.[

In addition to those behaviours mentioned above, there were psychologicasymptoms such as generalized fearfulness, separation anxiety, eating disorJersand feelings of shame and stigma. All of these problems noted by us in thelsraeli context have also been noted in a recent American review of pTSD i^children (Brett, Spitzer & Williams, 19BB).

The children also had difficulties in the interperconal reatm, often arising fror:unresolved intrapersonal issues concerning parental loss. This was revealed ir.two kinds of interpersonal reactions:

a. Early marriage: one of the chirdren married in his teens in order tccompensate for the loss of his father and mother, but divorced within a fenmonths of the marital nuptials.

b' Difficulties with interpersonal commitment Children demonstrated a:inability to maintain lasting interpersonal relations because of their earlie, i

unresolved parental loss. I

In line with the interactional view presented earlier, a multidimensiona Iinteractional approach to intervention with children who are pTSD victims , Isuggested. such interventive programmes should consider changing intrape.r- |sonal, interpersonal and situational events, as well as prior contingencies. o- |the individual level, for examplg it has been shown that children initia-,, I

i[ffi J" ;",fiff #.:l r':f ';ffi ' Il?*:::: :l T,Tffi Xffi: ji:?# f .

I-{,

Children in tansition and crisis

abreaction and a sense of mastery and adjustment. However, while abreactivetherapy may ultimately diminish feelings of helplessness and loss of control (Eth

& Pynoos, 1985) caution should be exercised with regard to when therapy ofthis nature, designed to decrease defensiveness in the trauma victim, should beapplied. In the initial stages of the trauma where the victim is ovenryhelmed byarxiety and shock, defensive denial may be normative and beneficial, andcontribute to the victim's day-to-day optimism and coping (Lazarus, 1985).Removing such defences prematurely may exacerbate already high anxietykvels resulting from traum4 thus negatively affecting coping and adjustmenlWhen stress and anxiety levels decline, intervention promoting abreaction,designed to work through archaic feelingp of loss and helplessness (thuscontributing to reallty testing and long-term adjustment), may be moreappropriate.

on the interperconal level it has been noted that a typical reaction oftraumatized adolescents is a premature entrance into adulthood, such as thatmanifested in early marriage. Such behaviour is often meant to compensate forfeelings of loss and helplessness related to the murder of family members (Eth APynoos, 1985). lt is suggested that such disturbing interpersona! behavioursmight be reduced through abreactive therapy which diminishes these archaicfeelings. Such intrapsychic abreaction might then later facilitate parental limitsettint since there would be a diminished need for compensatory behavioursby these child victims. This is an important issue in post-traumatic recovery asenidenced by our findings and those of Martini et a/. (1990), namely that failureto set limits for PTSD child victims may further exacerbate theirsymptomatology and feelings of loss of control. Thus different individual andinterpersonal intervention strategies, properly sequenced, may complementeach other in facilitating children,s post-traumatic adjustment.

lnterventive work should also consider how substitute parents can be helped tobe effective with children who have lost a parent through terrorism or othertragic circumstances. Our work with child victims of terrorism (Dreman, 1989;Dreman & cohen, 1990) suggests that substitute parents are plagued byfeelings of guilt and pity, resulting in them experiencing difficulties in settinglimits for these children. Parental substitutes might be cautioned that they

Childrq in transidon and cdsit

should not give up their mandate to be a parent under these circumstances. hshould be noted that failure to establish effective limit setting may exacerbatgrather than diminish, existing feelings of insecurity in these children. Thb

follows, since parental authority and limit setting provides these child victirns

with a sense of security in the face of archaic trauma-precipitated feelings ofhelplessness and loss of controt. lnterventive work with steP-Parents has also

shown that they must be helped to overcome unrealistic expectations like tlptt*yth of instant lovefr that o(pects that step-parent and step-children wilinstantly love each other (Visher & Visher, 19781.|t should be explained tl'rat

such relationships take time to develop and feelingp of affection and love mustnot be expected instantly but rather be allowed to evolve as time passes. Sudrinterventions should promote parenting which provides both discipline and

warmth, or what has been called rfauthoritativerr parenting Eaumrind, 1971;

Maccoby & Martin, 1983), and contribute to optimal adjustment in these child

victims.

ln lsrael interpersonal factors related to the family, BrouP and community have

proved to be particularly effective in helping overcome P[SD. Thus recovery

has been shown to be promoted by family cohesiveness (Solomon et al.,1987h

the sharing of feelings in the family (Ayalon, 19830 Sroup treatment whidrfocused on coping with Iife's problems and conflicts rather than on individual

pathology (Ben Yakar, Dasberg & Plotkin, 197$; and communlty supportsystems which emphasized the normative non-pathological nature of severe

trauma reactions (Toubiana et aL, 1988).

On the situational level, lsrael is prone to ongoing violence and aggression

which may precipitate or retrigger PTSD. ln our study most of the child victimsdisplayed diffuse anxiety and psychosomatic symptoms on the eve dcompulsory military duty at age 18. This is not surprising due to the commonlife-threatening nature of terrorist activity and military service. Compulsorymilitary induction may hence awaken latent anxieties that a common fate -death - will be shared with the deceased parenL lnduction is therefore a

predictable, high-risk and culturally-linked stress factor which affects post-

traumatic adjustment and may require preventive intervention in the case dknown PTSD victims.

Ir

Children in tansition and cl"isrs

Srdden traumatic events may also influence adjustment through recall and&reaction. One of the children in our study witnessed the explosion of a busi: years after her father was killed by terrorists. This resulted in the familyniewing and discussing the originaltraumatic events for the first time. This intrn promoted better adjustment. Thus the occurrence of traumatic events infie PTSD victim may predispose the individual to abreact, promoting betterdistment and/or rendering him/her more amenable to therapy.

L Pen*ormative events

hreIfrrcrce is a |tpara-normativetr event ffe*elson, 1980) which has recently beenfun to be of a traumatic nature (Dreman, 1991). Eth and Pynoos (1985) havecrpared the reactions of children of divorce to the post-traumatic reactionsd dfdren who had witnessed the homicide of a parent Confirming thisfrical observation is a recent review of divorce research which shows thathrediately following divorce children show PTSD sympto-matology such as

fttt shame, arxiety, pessimism, depression, guilt and recurrent intrusiverrdectisns of the traumatic events (Dreman, 1991).

f ncent review by Dreman (in press) of children's postdivorce adjustment

FEeives this process as multidimensional and dynamic. While initialrttnent may be largely determined by intrapersonal child-related variablesdt as tlre child's age, gender and temperament, long-term adjustment is to art Gxt€nt determined by interaction of the developing child with changingl:rpersonal and situational variables such as the post-divorce family

-rre, post-divorce parental co-operation or conflict, family coping

Hrenbms, social support systems and situational changes in socio-uunic status (SES), residencg habits and routines. On the broader societalhr[ pwailing attitudes towards single-parent families may also influence

{Pner*. To illustrate a few of these influences family structure, familyqi; ard certain situational factors are considered:

Yt Wy *uaure. Boys tend to adjust better in the custody of fathers, whilejib tend to adjust better in the custody of mothers. Since mothers usually

Children in transioon and cnsis

obtain custody, findings concerning children's post-divorce adjustment

have usually shown that boys' adjustment is poorer than that of girls'

However, these differences tend to decrease with age. Zaslow (198S; 1989)

has recently reviewed such sex differences and suSSested that one of the

reasons for these differentials decreasing is the fact that, usually, the

mother remarries and introduces a stepfather into the household. For boys

this often improves adjustment since the stePfather may represent a new

father figure (Kalter, $n). However, for girls living with a mother, the

introduction of a stepfather may be troublesome, interrupting a close

mother-daughter relationship and often resulting in poorer adjustmenl

A recent study (Zimiles & Lee, 1991) supports Zaslou/s contentions. This

study showed that boys displayed Poorer adjustment in single'parent

families and better adjustment in intact and stepfamilies, whereas girls

show poorer adjustment in stepfamilies and better adjustment in intact

and single-parent families. This is probably because the modal single-

parent family is mother-headed and the modal stepfamily comprises a

stepfather and a biological mother. Cirls fare better in single-parent than

stepfamilies because they have an exclusive relation with the same-sexed

paren! while boys fare better in a stepfamily because they usually obtain a

same-sexed step-parent, which can neutralize the problematic mother-son

relation.

(b) Famity coping. Recent research shows that coping patterns in divorcecj

parents change over time (Dreman, Orr & Aldor, 1989; 199O). Women in

the early ttaftermathff (median separation four months) phase of divorce

tend to deny and overrate their parental competence, while women in the

later ffrealignmentrr phase (median separation 22 months) engage in less

denial and better reality testing - their ratin6s of parental competence

being lower and more congruent with their low levels of parental efficaq'than those of women in the early aftermath period. In the finarrstabilizationfr phase (at least four years after divorce) women were

found to have high ratings of parental competence which were congruent

with, and realistically reflected, their high levels of parental efficao(Dreman & Aldor, in press). This has important adjustment implications for

Children in tansitlp,n and oisis

children since women who denied difficulties by overrating parentalcompetence were found to have children with lower levels of self-esteemcompared with women whose competence ratings accurately reflectedtheir parental efficary. These findings supported the interactional thesis inthat children's post-divorce adjustment was found to be a function of post-divorce parental coping/reality testing.

I Situational fac:tors (stability of the post4ivorce environmen0. The mostsignificant limitation of research linking child adjustment to divorce is thefailure to control for income and SES (Demo & Acoc( 19BB). When SES is

controlled, children in single-parent families adjust as well as those in intactfamilies ( Peterson &2i11,1986). While custodial mothers usually experiencediminished incomg custodial and non-custodialfathers usually maintain orimprove their standard of living after divorce (Hetherington & Stanley-Hagan, 198n. Research comparing adjustment in paternal as comparedwith maternal custody families must, therefore, control for SES sincesuperior adjustment reported in patemal custody families may be due tothis factor (e.g. Ambert, 1982; 1984).

Other situational factors such as change in residencg changed routinesand habits and change in work status of the divorced mother have alsobeen shown to adversely affect post-divorce adjustment (Dreman, inpress).

This interactional perspective of divorce adjustment has importantinterventive implications, as well as implications for family advocates. Arecent meta-analysis of divorce research has shown that family conflict is

the largest single predictor of poor post-divorce adjustment (Amato &Keith, 1991'), whereas parental co-operation contributes significantly togood post-divorce adjustment (Camara & Resnick, 1989). lnterventionwhich encourages post-divorce parental co-operation should, thereforgresult in better adjustment despite the change in family structure due todivorce. As for the legal aspects of divorce, the findings that children farebest with the same-sex parent may have important implications in the caseof custody disputes between divorcing spouses.

11

Childrcn ln tansition and c-::

C. Normative life'cycle transitions

Like traumatic and para-normative events, normative life-cycle transitions can

be understood in a dynamic multidimensional nested context in whidr

individual development occurs as an ongoing dialectic between the individud

and the demand characteristics of the family life-cycle stage or situation in

which one is located. Marriagg the birth of a child, adolescence, middle a$q,

the empty nest and the aging family are life-cycle stages which require the

individual to undergo attitude changg emotional integration of changed

realities, and adaptive behaviour/role change. ln accordance with thc

interactional model, change is promoted through reciprocal accommodatiqr

between the individual, the family and society over time.

ln adolescence, for example, a youth's pursuit of autonomy is facilitated by the

parents' abiliry to pursue other interests and/or consolidate intimacy in theiown couple relationship, thus facititating itletting goft of their developing yorrhSimilarly, a young couple who have their first child must redistribute energieq'

previously devoted to their spouse and extra-familial pursuits, to include dreinew roles as parents of an infanl

Changing societal contingencies may affect this adjustment Process. In tlpzoth ien1ury the birth of a first child has been labelled tfthe

Pressure cookrstagefr (Carter & McGoldrick, 1988), since it conflicts with women's increas*rg

aspirations for career and personal development outside the family. Related othis is the finding that this is a period characterized by the highest divorce rates

in the entire family life cycle. Cood adjustment might require a process cm

mutual accommodation by the young couple in which Parentint duties

shared in such a way that both career aspirations and the couple's need

intimacy can be satisfied. The lack of such a reciprocal accommodation,considers changing individual, familial and societal influences, ffioY

to poor long-term adjustment and perhaps pathology.

12

Children in transroon and qisis

Summary

Children's adjustment to transition and crisis was examined from aninteractional point of view. Traumatic events involving injury terrorism anddivorce were discussed, as were processes of normative transition in the familylife rycle. lt was concluded that long-term adjustment in children and theirfamilies is a function of the ongoing interaction of the developing child withdranging interpersonal and situational factors. lmplications for treatment andlntervention were presented. Carefully designed longitudinal research, whichhvestigates how changing interpersonal and situational contingencies affectirdividual adjustment should help the clinician and educator deal moreeffectively with children and families in transition and crisis.

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