Summary: Saigh PA, Fairbank JA, and Yasik, AE. "War-related posttraumatic stress disorder among children and adolescents," in Miller TW, ed, Children of Trauma: Stressful Life Events and Their Effects on Children and Adolescents. 119-140. Madison, Conn., International Universities Press. 1998.

Research on children and adolescents traumatized by war is still not as advanced as research on adult civilian and military survivors of war. This article reviews the history of this research, discusses problems of measuring and classifying trauma's effects, describes what is known about the epidemiology of the problem, and suggests directions for future research.

During World War Two and in the period just after, researchers noted the psychological effects of warfare on children. Nightmares, avoidance of war-related thoughts and images, academic problems, and emotional numbness were observed in children by mental health professionals across Europe. These symptoms parallel many of the features that were to be formalized in the diagnosis of posttraumatic stress disorder (PTSD) that the American Psychological Association established 40 years later.

Most of the research on establishing the validity of PTSD as a diagnosis has focused on adults. Researchers have sought to determine whether the diagnostic criteria for the disorder also apply to children. While more research in young subjects will need to be done, both diagnostic tests and clinical observation of children and adolescents who have been diagnosed with PTSD suggest that the diagnosis is a valid one.

But not all children exposed to warfare emerge from the experience deeply traumatized, and the symptoms even among those who suffer greatly may lessen over time. Epidemiological studies measure how widespread a disease or disorder is in a given population. While large-scale studies of adults-such as war veterans-have been conducted to determine how widespread postwar PTSD and other psychological problems are among that population, only smaller-scale studies of children have been conducted.

In this article the authors review seven studies that report on emotional problems-apart from PTSD-of children in Britain during World War Two, in Israel during the Arab-Israeli war, and in Beirut during the Israel-Lebanon war. Only one of the studies saw negative psychological outcomes in a majority of the children studied. Where problems were found, in many cases they eased when the political situation became more stable. Small studies among survivors of Cambodia's Pol Pot regime, Lebanese survivors of the Israel-Lebanon war, and Kuwaiti children who lived through the Gulf War specifically assessed the presence of war-related PTSD in children. The current prevalence of PTSD in these children and adolescents ranged from 9 percent to 70 percent, and lifetime prevalence was 21 percent to 90 percent, depending on the study.

In the future, the authors conclude, there are a number of directions where researchers should focus their efforts. Larger epidemiological studies would aid not just in measuring the presence of PTSD, but in understanding its development, identifying risk factors for the disorder, and discovering protective measures. Longitudinal research would deepen knowledge about how war-related trauma is experienced in different age groups and how individuals' psychological reactions to trauma may change over time. Researchers also need to take into account cultural and gender variations in the assessment, course, and treatment of PTSD and other postwar psychological problems.