Abdulbaghi Ahmad

Posttraumatic stress disorder in children after the military operation "Anfal" in Iraqi Kurdistan

Abstract Five years after the military operation “Anfal” in Iraqi Kurdistan, 45 families were randomly selected among the survivors in two displacement camps. The Posttraumatic Stress Symptoms for Children (PTSS-C) and the Harvard Trauma Questionnaire (HTQ) were administered to the oldest child and the caregiver in each family, respectively. Posttraumatic stress disorder (PTSD) was reported in 87% of children and 60% of their caregivers. While childhood PTSD was only significantly predicted by child trauma score and the duration of captivity, it was neither predicted by maternal PTSD nor did it disappear after the reunion with the PTSD-free father. However, the small sample size makes the results hypotheses rather than conclusive.

EMDR treatment for children with PTSD: Results of a randomized controlled trial

The objective of the study was to examine the efficacy of EMDR treatment for children with post-traumatic stress disorder (PTSD) compared with untreated children in a waiting list control group (WLC) participating in a randomized controlled superiority trial (RCT). Thirty-three 6–16-year-old children with a DSM-IV diagnosis of PTSD were randomly assigned to eight weekly EMDR sessions or the WLC group. The Posttraumatic Stress Symptom Scale for Children (PTSS-C scale) was used in interviews with children to evaluate their symptoms and outcome. Post-treatment scores of the EMDR group were significantly lower than the WLC indicating improvement in total PTSS-C scores, PTSD-related symptom scale, and the subscales re-experiencing and avoidance among subjects in the EMDR group, while untreated children improved in PTSD-non-related symptom scale. The improvement in re-experiencing symptoms proved to be the most significant between-group difference over time. The results of the present exploratory study including a limited number of children with PTSD are encouraging and warrant further controlled studies of larger samples of children suffering from PTSD.

Treatment of traumatized refugee children with Eye Movement Desensitization and Reprocessing in a psychodynamic context.

This study examines the effects of a psychodynamic approach of Eye Movement Desensitization and Reprocessing (EMDR) in treatment of traumatized refugee children. Among a child psychiatric outpatient refugee team, 13 children with post-traumatic stress disorder (PTSD), were treated by EMDR incorporated in a traditional psychodynamic therapeutic approach. The Posttraumatic Stress Symptom Scale for Children (PTSS-C) and the Global Assessment of Functioning (GAF) were administered before and after the treatment, to measure the effects. After treatment, a significant improvement was noticed in the functioning level and all PTSS-C scales, mostly in re-experiencing and least in the avoidance symptoms. The improvement in the functioning level was significantly correlated with the reduction of the PTSD-non-related and the depression, but not with that of the PTSD-related symptoms. Used in a psychodynamic context, EMDR is suggested to be effective treatment for traumatized refugee children. Our findings support the hypothesis of child-specific criteria for PTSD.

Reliability and validity of a child-specific cross-cultural instrument for assessing posttraumatic stress disorder.

Abstract The Posttraumatic Stress Symptoms in Children (PTSS-C) was developed as a cross-cultural semi-structured interview to diagnose posttraumatic stress disorder (PTSD) and to identify PTSD-non-related posttraumatic stress symptoms in children after various traumatic experiences. The psychometric properties were studied in two different child populations in Iraqi Kurdistan (the survivors of the military operation “Anfal”, and the orphans), in a sample of Kurdistanian refugee children in Sweden, and in a comparison sample of Swedish children. The instrument yielded satisfactory internal consistency, high interrater agreement, and excellent validity on cross-validation with the Child Posttraumatic Stress Disorder Reaction Index (CPTSD-RI) and the Diagnostic Interview for Children and Adolescents (DICA) according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

Applying EMDR on children with PTSD

ObjectiveTo find out child-adjusted protocol for eye movement desensitization and reprocessing (EMDR).MethodsChild-adjusted modification were made in the original adult-based protocol, and within-session measurements, when EMDR was used in a randomized controlled trial (RCT) on thirty-three 6–16-year-old children with post-traumatic stress disorder (PTSD).ResultsEMDR was applicable after certain modifications adjusted to the age and developmental level of the child. The average treatment effect size was largest on re-experiencing, and smallest on hyperarousal scale. The age of the child yielded no significant effects on the dependent variables in the study. ConclusionsA child-adjusted protocol for EMDR is suggested after being applied in a RCT for PTSD among traumatized and psychosocially exposed children.

A 26-month follow-up of posttraumatic stress symptoms in children after the mass-escape tragedy in Iraqi Kurdistan

In the aftermath of the Gulf War, an Iraqi military attack caused a mass-escape tragedy in Kurdistan. Two months later, a sample of displaced children on the Iraqi-Turkish border reported a high frequency of post-traumatic stress symptoms. Twenty per cent of the examined children met DSM-III-R criteria for post-traumatic stress disorder (PTSD). After a decrease in symptoms at the 4-month follow-up, the 14-month follow-up showed a significant increase in PTSD-related symptoms, which persisted even at the 26-month follow-up. The results are discussed in relation to the specificity of PTSD symptoms, their course over time, and the sociocultural aspects in measuring post-traumatic stress symptoms.

Symptoms of posttraumatic stress disorder among displaced Kurdish children in Iraq - victims of a man-made disaster after the Gulf war

After the Gulf war, the Iraqi military attack on Kurdistan intensified and resulted at the end of March 1991 in a sudden and almost total evacuation of the area in northern Iraq. Being exposed to the military actions, including fire from helicopters and artillery, and because of fear of chemical weapons, more than 3 million people were forced to leave their homes in panic and to move towards the borders of Turkey and Iran. Among those families who were displaced in temporary camps on the Turkish border, 20 children aged 6-16 years were interviewed about their experience of stress symptoms, focusing on posttraumatic stress disorder (PTSD) in particular. The interviews were conducted 2 months after the disaster and again at a 2-month follow-up when the children had returned with their families back to the home regions. All of the examined children showed some PTSD symptoms. At the index interview, however, only four of them fulfilled the criteria for PTSD according to DSM-III-R, and none of them did so at t...

Traumatic experiences and post-traumatic stress reactions in children from Kurdistan and Sweden.

This paper examines the types and scores of traumatic experiences, post‐traumatic stress symptom and behavioural disorders among Kurdistanian refugee children in Sweden and a comparative Swedish group. The Harvard‐Uppsala Trauma Questionnaire for Children (HUTQ‐C), the Post‐Traumatic Stress Disorder for Children (PTSS‐C) and the Child Behaviour Checklist (CBCL) were administered in interview form to 32 children from each sample, controlled for age, gender and trauma levels. No significant differences were found between the 2 samples regarding types of traumatic events, frequencies of post‐traumatic stress disorder, post‐traumatic stress symptom scores or behavioural problem scores, except in 3 aspects: Kurdistanian children reported more war experience and being lost, while Swedish children presented higher frequencies of leisure‐time accidents.

Reporting questionnaire for children as a screening instrument for child mental health problems in iraqi kurdistan

To identify child mental health problems in a mid-sized to large city in Iraqi Kurdistan, the Reporting Questionnaire for Children (RQC), followed by the Child Behaviour Checklist (CBCL) and the Post-traumatic Stress Symptom Checklist for Children (PTSS-C), were administered in interview form to the caregivers of 806 school-aged children. To cover different categories of children, four samples were randomly selected from among the general population (n = 201), orphans (n = 241), primary medical care patients (n = 199), and hospital patients (n = 165). The RQC revealed satisfactory validity against a deviant CBCL cut-off. The screening capacity of the RQC was further supported by its similarity to the CBCL in distribution of problem scores among the four samples and its positive correlation with the CBCL, but not with the trauma-related PTSS-C. Although the general population showed lower problem scores than the orphans and the two clinical samples, problem scores in all instruments were considerably higher than those reported from other societies. The RQC seems to be useful as a first-stage screening instrument for child mental health problems in Kurdistan.

Psychiatric Morbidity among Street Children in Duhok

Background Due, in part, to family constraints in dealing with the economical burden of raising a family, a wave of street children is sweeping the developing world. Such children are prone to both somatic and mental illnesses. This is the first ever study that has been conducted to explore the psychopathology among street children in the Duhok Governorate. Methods The study was conducted between March 2004 and May 2005 in Duhok City among street children who attended the Zewa Center—the only center for street children in the region at the time of the study. Among a total of 107 eligible children, 100 agreed to participate (93% response rate). A modified family map (genogram) was used to obtain demographic data from the children and their caregivers through semi-structured interviews. In addition, the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) structured interviews were conducted with the children. Results The study found that 98% of children worked on the street because of the economic need and pressure on their families. There was high rate of parental illiteracy (90% of fathers and 95% of mothers), and 61% of respondents were shown to have at least one psychiatric disorder. A high percentage (57%) of these children suffered from anxiety disorders including posttraumatic stress disorders (29%). Ten percent had depression, and 5% had attention deficit hyperactivity disorder. Conclusion Street children in Duhok seem to be working children due to their families’ needs.