Abstract: Transactional cascades among child internalizing and externalizing symptoms, and fathers’ and mothers’ posttraumatic stress disorder (PTSD) symptoms were examined in a sample of families with a male parent who had been deployed to recent military conflicts in the Middle East. The role of parents’ positive engagement and coercive interaction with their child, and family members’ emotion regulation were tested as processes linking cascades of parent and child symptoms. A subsample of 183 families with deployed fathers and nondeployed mothers and their 4- to 13-year-old children who participated in a randomized control trial intervention (After Deployment: Adaptive Parenting Tools) were assessed at baseline prior to intervention, and at 12 and 24 months after baseline, using parent reports of their own and their child's symptoms. Parents’ observed behavior during interaction with their children was coded using a multimethod approach at each assessment point. Reciprocal cascades among fathers’ and mothers’ PTSD symptoms, and child internalizing and externalizing symptoms, were observed. Fathers’ and mothers’ positive engagement during parent–child interaction linked their PTSD symptoms and their child's internalizing symptoms. Fathers’ and mothers’ coercive behavior toward their child linked their PTSD symptoms and their child's externalizing symptoms. Each family member's capacity for emotion regulation was associated with his or her adjustment problems at baseline. Implications for intervention, and for research using longitudinal models and a family-systems perspective of co-occurrence and cascades of symptoms across family members are described.
This report has three interlocking goals. The first examines the co-occurrence of externalizing and internalizing child symptoms for 2 years during family reunification following their fathers’ deployments to recent Middle East conflicts. The second goal is more novel. Co-occurrence (or comorbidity) focuses on the individual. We focus on describing sequential cascades of individual adjustment problems at a family- systems level following fathers’ military deployment to war zones and combat-related trauma exposure, a significant family transition that challenges family members’ adjustment (Gewirtz, Polusny, DeGarmo, Khaylis, & Erbes, Reference Gewirtz, Polusny, DeGarmo, Khaylis and Erbes2010; Lester et al., Reference Lester, Peterson, Reeves, Krauss, Glover and Mogil2010; Milliken, Auchterlonie, & Hoge, Reference Milliken, Auchterlonie and Hoge2007). Third, we use an ontological perspective to examine occurrence and co-occurrence of child externalizing and internalizing symptoms as a function of child and parent emotion regulatory processes, and whether the quality of parent–child relationships serve as key social processes that account for the concurrent and prospective linkages between parental posttraumatic stress disorder (PTSD) symptoms and child internalizing and externalizing symptoms. Child externalizing and internalizing symptoms and their co-occurrence are examined in a longitudinal framework with multiple levels: (a) the family system social context (transactional linkages and cascades of family members’ emotional and behavioral symptoms), (b) the individual vulnerability of each family member (negative emotion reactivity and dysregulation), and (c) the quality of the relationships between family members as assessed by observed parent positive engagement and coercive behavior during interaction with their children.
The following sections describe the multilevel variables included in the hypothesized cascade model. We describe the unique family–developmental transition, which serves as a context for the hypothesized models: fathers’ deployment and trauma exposure during military service in the Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) conflicts. Next, we describe research and theory related to co-occurring child internalizing and externalizing symptoms, and the covariation and cascades of emotional and behavioral problems across family members. Finally, we examine social processes that may link parental PTSD symptoms with their children's development of internalizing and externalizing symptoms, and how children's symptoms, in turn, may affect ongoing parental adjustment.