What parents need to know: how war and occupation affect children's psyche

Occupation is a part of the war that some Ukrainians have lived through and are still living through. This experience is difficult for adults, and even more so for children. The lives of children in the occupied territories show no signs of a happy childhood. They are forced to adapt to the realities that leave a deep mark on their psyche, affecting the development and formation of their personality. How to provide these children with the necessary psychological assistance? How can we restore them to ultimate stability and help them adapt to the return of life after the occupation

UNN talked to Marta Pyvovarenko , head of the department of "Quality Assurance of MHPSS Services" at the NGO "Self-Help Communities", and a professional psychologist , about how the occupation affects children's psyche, how they adapt to life after the occupation, children's guilt and the impact of interrogations.

how does occupation in general affect a child's mental state?

The period of occupation is quite difficult to live this experience for several reasons. First, it is exhaustion. Because the occupation implies a decrease in access to everything that covers our basic needs. We know the period of the encirclement of the Chernihiv region, for example, when people were starving. This has a much stronger impact on children than on adults, because the child's development depends on proper care. Very rapid development occurs in the earliest years, and the smaller the child, the more even purely physical parameters such as food, water, hygiene will affect how the child develops or regresses. Even without taking into account the risk factor of experiencing violence,  living conditions will already have an impact on increasing the psychological consequences for the child.

That is, the occupation, in addition to all these things, the inability to learn, the interruption of development, the child's feeling that his future is impossible, circumcised, all this causes very serious psychological consequences. Children  have significantly less psychological resources than adults, and children are highly dependent on adults and their condition. The possibility, for example, of losing the main figure of the caregiver, that is, the mother, the father, will also greatly affect the child. But for each age, of course, there will be some different problems during the life of this period. Because teenagers are more mobile, they can, even after the death of close relatives, fight, try to escape, for example, from concentration and filtration camps. Smaller children, of course, will not be able to, so they are even more likely to be abused, due to their height, age and dependence on adults. 

What are the consequences of the experience?

The child may exhibit regressive behavior, his or her thought process may deteriorate, and there may be a learning disability. In general, there may be problems with concentration, memory, and speech disorders. It is even possible to return to the previous level of development, that is, the child can wet the bed, can suck his or her finger. That is, at an older age, to return to such very basic methods of calming. Children are living through the occupation quite seriously, and it seems to me that our society is more inclined to treat children as little adults, but nature says otherwise, that their reactions will be much faster. They will react much worse to negative growth conditions, to violence. Nature has laid down a better level of recovery for children, i.e., children recover about 50% faster, if they have experienced something terrible and even developed psychological problems, then with sufficient good care, a positive social environment, and the restoration of routine, they will recover faster.

There is a popular opinion now that Ukrainian children have grown up quickly because of the war, do you agree with this and how does it affect them psychologically?

Psychologically, a child who is faced with the circumstances of having to take care of himself or herself on his or her own is forced to grow up, as this will affect his or her survival. We understand that the loss of someone close to them, which happens under occupation, or separation from family members will also provoke the need to look and behave like a more adult. I can't say that this is typical for very young children. When we talk about the circumstances of rapid maturation, we already assume that the child is about six and under 18, that is, that his or her age is not too young. More often than not, children will still develop a regression. It is meant that they will manifest themselves as smaller, as younger in age, but circumstances, especially related to the need to take care of younger brothers and sisters, will stimulate the child's behavior as if he or she were an adult. Especially if it is the parent who is motivating this. When a father tells his son that now you are the most adult. Why a father? Because this is still a professional model of behavior, that is, it is a professional component, and it is more typical of the behavior of a male adult. It can be any male caregiver.

Do children recover from such injuries more easily than adults? How does it work?

The speed of recovery is related to the natural resilience (a mental state in which traumatic events are easier to experience - ed.) of children, that is, nature has laid down a higher level of recovery for them. This means that they will simply recover faster in time. But children still develop mental health problems, such as depression or post-traumatic stress disorder, anxiety disorder. It's just that if they are given proper help and cared for, they will recover faster. While an adult can spend six months there, a child can recover in 3-4 months. That is, the speed of recovery, when we say that the problem of experiencing violence is related to the fact that the child does not fully realize that it was violence. Sometimes the realization, especially of sexual violence, which carries a high emotional burden and can provoke trauma that will accompany the child for many years, does not come immediately. A child may not fully understand the sexual context, the context of harm, and only in time, when adolescence comes, can they fully realize what happened at an earlier age. That is, there is a capsulation, so to speak, of this difficult experience of violence.

Memory can also erase memories of experiences, as children are more likely to forget. This is obvious to us when we see that after 20 minutes of being at the funeral, for example, the child is distracted by something else: running, playing, making noise. This is more related to the nervous system of children, they can not maintain a certain context for a long time, they need to change activities, and the main part of a child's life is play activities. Therefore, it is natural that she is distracted by the game, so as not to think difficult thoughts that are associated, for example, with death. We also understand that everything depends on age, and the awareness of what death is, what violence is, children feel this only over time, more fully, their picture of the world is supplemented. And the frontal cortex is formed up to 25 years, so we understand that children have other needs in order to improve their recovery. 

What are the first signs that a child should be taken to a psychologist? 

The first warning sign is physical reactions, for example, if the child hallucinates, if the child has intense vomiting, constant nausea, chronic headaches, i.e. any such physical reactions will indicate that something is wrong and the cause must be found. For most parents, these are signals to take their child to the doctor right away. It is less typical to respond to changes in a child's behavior. Because we hope that it will go away. Mostly, behavioral changes are the clearest indicator that a child is going through a psychological process that is difficult to overcome on their own, and the child is no longer coping because their psychological state is overloaded. The change in behavior can be as follows: for example, a child has been joyful and contactful all his or her life, and now he or she is isolated, tries not to contact other children, is more tearful, it is very difficult to get out of this state and there is no relief after crying. It means that the child is really suffering. If this typical discharge, such as tears, for example, or laughter, does not give a sense of relief, then this is a bad sign. Changes in sleep patterns are also significant, if the child sleeps much less or much more, or wakes up constantly - these are also indications that it is better to consult a specialist and find either a biological or psychological cause. 

do all children who survived the occupation need this assistance?

Of course not, you can do without. What we are talking about here is that help will be needed if you observe clear, steady changes in the child's behavioral response, if his behavior has always been that he is there, more, perhaps, dreamy or minor, then there is no peculiarity in this. If his behavior is stable, then sudden changes may indicate that help is needed. But in general, if we talk about the percentage, it depends, of course, on the duration of the load. That is, the occupation of 3 days is much less than the occupation of 9 months, as in the Kherson region, for example. That is, I understand that the intensity of the psychological burden will have an impact here, as, for example, in Bucha, where even today you can still meet community members and hear about traumatic experiences, because there were a lot of them, and they affected everyone everywhere. Some people experienced it directly, others observed it, and it was, so to speak, a shared experience. Either the intensity or the duration is one of the important factors, and of course, what is important is how much violence was around, how little help there was, how little access to information there was. All of these factors will affect how the children's audience in that community feels in general. And, of course, previous experience partially influences: if a child had psychological problems before the occupation, then afterwards they will have more. More often than not, a child who has already shown health problems, communication problems, behavioral problems, will have their condition worsen.

how important is the role of a school or kindergarten in adapting to life after occupation?

You should send your child to school or kindergarten as soon as possible. Routine plays an important role in stabilizing the child's condition. There are three basic needs of all children. The first need is safety. This is understandable, and it is one of the reasons why parents try not to send their children to kindergartens and schools, especially in the territories close to the occupation. Because the Russian Federation pays increased attention to schools, kindergartens, and so on. For parents, safety  is important, they think that schools are less safe. But for a child, routine is a very important part of their recovery. A child who goes to school will be much more psychologically stable than one who does not go to school and takes online classes, or has no classes at all. Therefore, of course, a school or kindergarten, an inclusive center, plays an important role in the development of school-age children. If you can't send your child back to school for some reason, create a routine for them that is as close as possible to the previous period of their life, when they do these lessons at home, but on the same schedule as the school offered. That is, at the same time, as close as possible to what she lived, it will help her stabilize. It's also a great distraction.

The second important aspect is the development of the child and the continuity of this development. That is, the basic need, in addition to security, is continuity of development. A child who moves and loses a certain amount of social contact with friends may have this context as already traumatic, because her plans for the future as she saw it for herself are interrupted, and therefore, of course, it will be debilitating. A child may develop symptoms similar to those of depression. In other words, security and continuity of development - basic needs-will play a significant role and influence, but depending on the period, this will vary. Younger children are very dependent on growing conditions, older children are less dependent on this, they are more mobile, and they can move around on their own. It's the same with an adult - smaller children will be more dependent on it, so they are more likely to be at risk. When they are removed, they are accordingly looking for an adult already in Russia, in the Russian environment, because this is normal, it is a matter of survival. 

How to behave when a child shows aggression or, on the contrary, closes in on himself after an experience?

Aggression is a very good indicator that the child's emotional sphere is in a transformational period in terms of awareness. That is, aggression is a way of saying: something is wrong with me, please pay attention. And it is worth noting that aggression, anger is a child's statement that he or she is growing up and does not yet understand his or her emotions well enough. There can be a lot of these emotions, and they may not realize it. Very often we observe this behavior in children who are just going through puberty, and they have an increasing palette of hormones inside, and, accordingly, emotions outside. This palette is not fully accepted by the child, and at first he or she may not even accept that his or her body is changing. Any transformations in physical parameters will affect the psychological state, and this can manifest as aggression. For example, a child does not understand what feelings are really behind the fact that he or she feels beautiful, he or she has not yet fully accepted it because he or she does not understand these new feelings, and so he or she manifests it in aggression. External changes, such as black lips or something colored, are ways to release this internal tension. And it can give parents good material for building relationships, if parents do not perceive aggression as personal attacks, but perceive it as some kind of internal process in the child, which he or she is trying to communicate to others, or to call on others to help, to support him or her. 

does psychological care differ in general, depending on gender?

Yes, of course. Psychological assistance for boys will be based on building rapport, taking into account the stereotypes that exist in society about boys. It is difficult to deny that even from a very young age boys will say that they are defenders, that they should not cry. These stereotypes and prejudices about gender are formed very early. Therefore, a specialist should take into account the fact that a child will probably come with an upbringing that involves stereotypes. Girls are also subject to many standards of behavior that they must meet. For example, it is believed that girls should be calmer than boys, and that girls are more emotional than boys, so they need to restrain their emotions more. So dialogues about how you feel and the release of emotions will be easier with girls. With boys, it will be harder to establish this contact, and in general, talking about emotions, it is easier to provide psychological assistance to girls through psycho-emotional support - it will not work with boys. Boys want to develop new skills from a very early age, they are not very willing to talk about internal emotions, because there is a stereotype that boys should not experience any emotions at all. 

We now live in a world where everyone is actively using social networks, does the use of these social networks have any impact on children from the occupied territories?

Yes, they may have been infiltrated from social networks during the occupation. In general, the play space, both the one offered by social networks and the general play space for a child, is a certain basis for expressing yourself. And children are looking for this opportunity both on the internet and in the physical space. When a child systematically observes that their parents are business because they have phones, they want to copy them. And it is logical that from a fairly early age, our children depend on the use of phones in general, not just games. It's just that games are also an extra dopamine needle,  a lot of the pleasure hormone, because you win. Any living being wants to win, because for our brain, this means "you will survive, others will not survive", "you have the advantage of survival". 

And if we talk about children who still live under occupation, but, for example, see through social networks how everyone else lives a peaceful life, a different life, it can be traumatic, right?

The greatest impact will be on the child who has an unstable adult environment. That is, when a child is in occupation, it is important how adults took care of the context of perception of what is happening. This will play a crucial role. Here I would say that in the conditions of occupation, one adult simply plays a greater role than the whole society. The child can come to us to talk, and even just having fun there, we can touch him with several positive emotional remarks, as well as complementing his emotional sphere. There is more isolation in occupation, so a meaningful adult will play a bigger role, including a role in how the child perceives a positive future without occupation. That is, if an adult has supported the information about how children live without occupation positively with what awaits you in the future, then the child will enjoy the fact that other children have this opportunity, perhaps a little envious. If parents have a negative attitude to the fact that people live well without occupation, they will infect the child with a similar opinion, and this will significantly worsen his psychological state already in the occupation. That is, we must remember that this is very dependent on the parents themselves, the immediate environment that the child has.

Can children feel guilty after occupation and what to do about it? 

Guilt is probably a basic feeling experienced by people around the military context. A child experiencing occupation will react faster to these things, that is, if we are talking about a military context, then war exacerbates the need for survival, and children pay more attention to physical parameters, sports and productive stress relief than in stable conditions, as we have now. By the way, adults and teachers say this, which bothers them a little, that children pay more attention to survival parameters, even teenagers say that we are preparing for military service.

What advice can you give parents in general to avoid re-traumatizing their children?

A good method of psychotherapy is one that allows you to restore your psychological state and well - being, bad methods of psychotherapy only mask the impact, and then we can talk about retraumatization. That is, retraumatization is more likely in the context of war due to the fact that the problem was not solved. And this is not a new injury, it's just the opening of the same wound. First-choice therapies, such as cognitive process therapy and prolonged exposure therapy, have a cognitive basis and are based on cognitive theory. They say that retraumatization in the context of therapeutic contact is very strange. For example, for a child who has experienced war — related sexual violence, the context of trauma will be sexual violence. Therefore, when conditions are completely safe, only a quick and intense immersion in previous experience can prevent a full recovery. This can happen if the therapist, for example, excessively immerses the child again in that traumatic experience. In this case, there will be resistance to therapy, it is similar to drug resistance: if we are given medications incorrectly, at the wrong time, then we develop immunity and no longer respond to these medications. Similarly, in psychotherapy, that is, a child who visits a psychotherapist who does not work correctly with her will then react poorly to other psychotherapy. 

When choosing a specialist who would provide proper assistance, you should pay attention to several criteria that will show that this specialist is prepared, understands the context and will not aggravate the child's psychological problems. First of all, parents need to track the progress that occurs already in the first sessions. That is, if the child has already passed three or four sessions, but there is no progress, then this is already a bad sign that perhaps the specialist either did not devote due attention to the diagnosis and works with something wrong, or is too narrowly specialized and does not focus on the child's problem. 

About where to look for a specialist. There are communities of de-occupied territories where there is actually  access to psychotherapy. However, in other such communities, the only source of this assistance will be a school, kindergarten, inclusive center, and non-governmental organizations specializing in such issues. Personally, I recommend several organizations that specialize in de-occupied territories, based on feedback from families whose children were affected by the war. These are , for example, the foundation "voices of children", the projects "not trifles" and "Tatohab". But there are quite a lot of such services, so I recommend paying attention to reviews from friends, if there is such an option. Also, when searching for such organizations, you should pay attention to how diverse specialists are available in them. The important point is that they work in a multidisciplinary approach. This is when a team of specialists is joined, for example, by a speech therapist or sensory expert who will work with neurological consequences. 

during the occupation, people are often subjected to interrogations, and even more terrible, of course, when children are interrogated, how does this affect the psyche in general?

I have heard about a large number of cases just with the territories that are in the zone of our project, this is the Mykolaiv and Kherson regions, where children who tracked the movement of transport, military equipment of the Russian Federation and provided information to the Ukrainian military were tortured. And it is terrible to hear that children, Russians are tortured on an equal footing with adults. The only difference between the conditions they created for children, in the context of using former pre-trial detention centers and basements as Dungeons, is that they provided children with karimats so that they would not lie on bare ground. But the types of torture were absolutely equivalent to adult torture, which is surprising, since the child's physical capabilities are much smaller, and he can withstand much less. This is a crime against humanity, but we know that Russians neglect all the principles of conducting a civilized war, and this is one of the ways to fight for Russians, apparently due to our freedom-loving nature and the fact that our genetic material does not exactly fit the totalitarian system, our children use phones and resist the occupation, even in dangerous conditions, even having parents who do not think so.

I can say that the use of torture against children will simply have more prolonged psychological consequences, returning to the fact that I said that many things the child realizes only in the process of growth. She may then have so-called long-term post-traumatic stress disorder, which means that the child may not have symptoms of post-traumatic stress disorder now, but will have symptoms of post-traumatic stress disorder in the future. Because when awareness comes, what she experienced, at a later age, can trigger. Therefore, providing psychological assistance now, while she is small, will play an important role for the quality of life of this child throughout her life, because problems can arise at any stage.

Tell us a little bit more about your project "Supporting the psychological health of children in the de-occupied territories of Ukraine".

The project, in my opinion, is very important, and we went to it in consultation with a very large number of experts, specialists, so that it would complement all these activities that are already taking place in Ukraine in the direction of supporting children. To do this, we started consulting with Susan Song, who is a doctor of psychiatry at Harvard University and heads the Boston Children's Hospital at Harvard University, at the beginning of the full-scale invasion. We understood from World scientific experience that children will have prolonged consequences, because the body of Ukrainian children is no different from the body of any other children around the world. Understanding that such categories of children who, for example, survived amputation of a limb after bombing or torture — this will also accompany certain psychological needs. In other words, the prolonged consequences of war for children are a good reason why this project is taking place. 

After doing our preliminary "homework" during the year, we realized what the gaps in this topic are and what we need to do to fill in these gaps. It was determined that the first major problem was the lack of assistance as early as possible after the experience of occupation. This means that once a territory is vacated, children and their guardians should have access to psychosocial support, regardless of who provides them with this support in the de-occupied territories. First of all, this support can be provided by  military personnel related to civil-military cooperation. They were identified for us as the primary link with whom it is absolutely necessary to work, since they are the first to enter the de-occupied territories and are already starting to help, provide humanitarian aid and food. They need to know the basics of children's growth in order to understand that, for example, this family where there is a small child needs good nutrition, hygiene, and water. And help will be a higher priority for this family, since it is at a higher risk for psychological problems. Thus, we have prioritized civil-military cooperation for ourselves. Also, all the services that then work in this territory, that is, they are rescuers of the state emergency service, since arrivals occur, and each arrival is an additional traumatic source. Therefore, we understand that representatives of the state emergency service should be there. Also the police, because the response to such cases involves the involvement of the police, and they are the first to come into contact with children who are left unattended. Therefore, we understand that then the police and the state emergency service should also be well aware of the psychosocial needs of children. And we have prioritized for ourselves that all these classrooms, state — owned, plus mobile teams that are not government-owned, are mainly our task-to teach them to identify the needs of children. If they are able to understand these needs, it will reduce the psychological burden.   

Now we are trying to determine the needs of children in the occupied territories as accurately as possible: whether there will be more need for psychological services, what exactly should be done, how to provide this assistance, how to organize it technically. In addition, we are already moving from piloting to more systematic work, when we will develop the basics of group work, including with those who have already learned. That is, we will provide them with the opportunity, in addition to receiving information on how to support children and families psychosocially, to give them access to a form of work called training for trainers. We will train them, improve their skills, so that they can train others and do this work, both within their own structures and for the general public. That is, this is a complementary project that is based on a global course on mental health, psychosocial support for children in difficult life circumstances, all children who have survived the occupation in difficult life circumstances.