Children and Torture

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Children, torture and psychological consequences

Alayarian, A. (2009). Torture: Journal of Rehabilitation of Torture Victims and Prevention of Torture, 19(2), 145-156.
 
Impact of torture on children may vary depending on the child’s coping strategies, cultural and social circumstances. In this paper the author gives a brief introduction of the work the Refugee Therapy Center does with children, discusses the effects of torture on children and presents a vignette and some examples of clinical intervention.

* The International Rehabilitation Council for Torture Victims (IRCT)’s Journal on Rehabilitation of Torture Victims and Prevention of Torture dedicated Volume 19, No. 2, 2009, to the issue of children and torture. Here is just one of the most relevant articles for the issue of psychological evaluation of torture survivors who are children.

Note: The link below is to the article as shared by the Dignity-Danish Institute Against Torture library. You may also access and search the entire TORTURE journal at this link: http://www.irct.org/media-and-resources/library/torture-journal.aspx

Article was reviewed by Victor Chow, doctoral student in physical therapy at the University of Minnesota in 2014.
 
Background: In this article, the researchers discuss the work they do with children victims of torture at the Refugee Therapy Centre and provide recommendations for evaluation and treatment of the children. Four case studies are presented which help to describe the special considerations used when treating child survivors.
 
Child torture in underdeveloped nations: The researchers state that child torture still occurs in many places in the world and that child refugees are most often tortured. Girls are often also victims of sexual torture and these instances are often not reported. Children experience various forms of torture such as physical torture, mental torture, and emotional torture. Often, children are tortured to punish communities or their parents. Many children suffer from post-traumatic stress disorder, anger, sleep problems, difficulty concentrating, and symptoms of anxiety following experiences of torture. The researchers state that children who are refugees, child soldiers, part of conflicts, laborers, or impoverished are at the greatest risk of being tortured and that it is important to identify these risk factors and provide services for these children. The researchers also state that by becoming more knowledgeable about the plight of child victims of torture, people can become more effective at participating in international efforts to address the issue of child torture, help children at greater risk of being tortured, and address those who carry out the torture of children.
 
Child torture in developed nations: Children not only suffer abuse in underdeveloped nations, but they also suffer abuse in developed nations such as the United States and European countries. In these countries, immigrant children are often detained without their parents and jailed with criminals. Western European countries such as the United Kingdom also often do not have adequate resources to help refugee children. Refugee children also do not only experience tribulation in their home country, but they also experience tribulation during their escape to other nations and their application for asylum.
 
Consequences and Implications: These refugee children are not only most susceptible to torture, but once they escape, they have difficulty assimilating into their new environments and have difficulty developing and growing.  The researchers state that the physical therapist must be sensitive and respectful of the child’s past if they have been a victim of torture.  
 
Case studies: 4 case studies of refugee children are presented in the article. They each had different stories and coping mechanisms.
  1. Erik was a 12 year old boy from Africa who saw his family raped and killed. He could not focus and did not get along with others and was extremely withdrawn in therapy. Sometimes, he would cry during therapy and was not very responsive.
  2. Another boy named Aran was seven years old and witnessed an ethnic cleansing in his village. He also saw his family raped and beaten and killed. At the Refugee Therapy Center, Aran had difficulty sleeping and often had flashback of his traumatic events and had suicidal ideologies.  He also demonstrated little empathy and was often violent and aggressive.
  3. Another child named Ivan was from a war zone and was impoverished and isolated. He would have to sleep in the barn with animals and his food was put in the yard for him to eat. He also had difficulty sleeping and experienced flashbacks and did not communicate much.
  4. Finally, Misha was another child who was forced to shoot another child and saw his mother killed as well. He also is aggressive during therapy.
Conclusions: In conclusion, the researchers provide background information concerning child victims of torture (particularly refugee children). The researcher also describes case studies of refugee children and child victims of torture and describes their experiences and coping mechanisms. With this information, the researcher hopes to empower readers with knowledge concerning child victims of torture to better equip readers to address this issue.
Link: http://doc.rct.dk/doc/tort2009.2.7.pdf

Risk and resilience for psychological distress amongst unaccompanied asylum seeking adolescents

Hodes M, Jagdev D, Chandra N, Cunniff A. (2008), Journal of Child Psychology and Psychiatry, 49(7):723-32. Full article requires paid subscription.

Summary written for www.HealTorture.org by CVT Intern Joseph Walker: 

Across the world there are significant numbers of displaced and unaccompanied refugee children. They are sent away from their families or flee from their communities out of fear of persecution, organized violence, or war. Young people who experience war events and displacement have elevated rates of psychopathology, particularly posttraumatic stress disorder. Unaccompanied asylum-seeking children and adolescents (UASC) are a group who may have experienced a high level of such trauma, and thus would appear to be at increased risk of psychiatric disorder. The specific aims of this study were threefold: first, to investigate whether UASC had experienced a higher level of past adversities and war trauma than accompanied asylum-seeking and refugee children (ARC); second, to determine whether UASC had higher levels of psychological distress than ARC; and third, to identify which factors, including living arrangements, ameliorate the effects of this distress.

UASC were recruited through the City of Westminster local authority Department of Social Services. ARC were a subgroup from a study of adolescent mental health carried out with students at a secondary school in the City of Westminster. Recruitment to the study was facilitated by the involvement of the allocated social workers for the young people, who were able to introduce the investigator or discuss the study prior to the investigator contacting the subjects. There were 78 UASC and 35 ARC, both groups having the same median age of 17 years, and no significant differences with regard to gender for the groups. The interviews and assessments took place either at their place of residence or at social work offices. The questionnaires of psychological distress were completed by the participant, or the investigator when there were literacy difficulties. Past war trauma events were assessed using the Harvard trauma questionnaire, which covers 17 types of maltreatment and traumatic events. The study found that UASC had experienced a much higher level of total traumatic events than ARC. The UASC group experienced on average 6.83 traumatic events, compared to 1.29 for the ARC group (p-value = .000). The two groups were investigated for posttraumatic stress symptoms for each gender separately using the Impact of Event Scale (IES), for which a score of 35 is the threshold for high risk of developing PTSD. Male UASC children had a mean score of 36.98, while ARC males had a mean score of 15.33 (p-value = .001). Female UASC scored 42.27 on average, with ARC females scoring 21.88 (p-value = .000). 61.5% of UASC males and 73.1% of females were determined to be at a high risk for developing PTSD.

UASC were predominantly living in foster families or semi-independent or fully independent arrangements. Posttraumatic stress symptoms were significantly higher amongst those in low-support living arrangements (living independently or semi-independently). The finding that post-traumatic stress symptoms are increased in lower-support living arrangements suggest that foster family living and high support may ameliorate posttraumatic stress, as well as provide general support. However, larger sample sizes and inclusion of interview measures of psychopathology would have strengthened the study further. There are a number of implications of this study. From the clinical perspective, it is important for those working with unaccompanied asylum-seeking adolescents to be aware of the high level of past war trauma, including injuries and sexual assault, that might affect their physical well-being. Mental health practitioners need to be aware of the high risk of posttraumatic stress disorder. Together with professionals in the child welfare agencies they should contribute to early detection for those who are highly distressed and whose difficulties appear to be persistent. 

Link: http://onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.2008.01912.x/pdf

The mental health of children affected by armed conflict: protective processes and pathways to resilience

Betancourt TS, Khan KT (2008), International Review of Psychiatry; 20(3):317-28.

This paper examines the concept of resilience in the context of children affected by armed conflict and presents key studies in the literature that address the interplay between risk and protective processes in the mental health of war-affected children from an ecological, developmental perspective.
Note: Requires paid subscription - link is to abstract.

Link: http://informahealthcare.com/doi/pdf/10.1080/09540260802090363