Many US military families have faced separations of at least 1 family member for extended periods of time. This article shows how changes in military culture have increased the repercussions for military families, and especially for military-connected children. This article provides an introduction to aspects of military culture that are most applicable to children, an overview of important aspects of childhood development, a discussion of the impact of deployment on the emotional development and behavior of children left at home and their caregivers, and a review of some interventions and resources available to help these families navigate these challenges.
Key points
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Military culture has changed in recent years, increasing the likelihood that military-connected children will be affected by stresses unique to military life.
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Military deployment, resulting in separation of parents from their families for long periods of time, has repercussions on child development and behavior.
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Interventions to strengthen family resilience and parenting skills/coping have shown promise in mitigating potentially negative outcomes following deployment.
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More research, including longitudinal studies of military families, is needed to design further interventions and to bolster policies that support military families.
Introduction
In 1973, the US military initiated a significant shift within its own culture, transitioning from a draft force to an all-volunteer force (AVF), and consequently the lives of military families has gained increasing importance in military policy. Before this time, most who embraced the military as a lifelong career tended to be senior military service members, with most of the force consisting of young, unmarried men who served a tour and transitioned to civilian life before beginning a family. With the introduction of the AVF, larger groups of younger service members joined and remained in the military, and the growing population of junior military service members began families and chose the military as a career. The AVF military has seen the longest sustained deployment of service members to Afghanistan and Iraq ; consequently, deployment has become a way of life for military families, with stateside family members serving the military in their own unique ways. The welfare of military families has gained attention at the nation’s highest levels with President Obama declaring “the care and support of military families a top national security policy priority.”
Provision of this care occurs in medical and mental health practices across the country. The scope of clinical practice involving military-connected children is broad, because of the widespread presence of military families in communities across the United States, many of which do not surround military installations. For the purposes of this article, the military family is defined as the spouses and dependent children of active duty (AD), National Guard, and Reserve military service members; many of the available studies involve current military-connected children, although the authors recognize that there are many other affected families of military veterans.
Military culture
Demographics
With the growing number of military service members remaining on AD while they begin families, military family members outnumber military personnel by 1.36 to 1, and there is a growing diversity of family forms. In 2014, 665,619 spouses and more than 1.12 million dependent children lived in AD families, and 381,773 spouses and 699,835 dependent children lived in Guard and Reserve families. Another 2 million children are dependents of veterans, bringing the total number of military-connected children to 4 million.
Some specific financial and social circumstances create an environment in which military members are more likely to be married and to have children at younger ages compared with civilian counterparts. Almost all military service members have high job security for a contracted service commitment typically lasting a few years, and active military members have higher income levels than civilian counterparts in many career fields. Increased housing allowance following marriage, the presence of stable health care for the entire family, and the provision of quality day care and other family support services all remove some of the potential financial barriers to beginning a family at younger ages. The military tends to draw people with conservative family values, thus increasing the likelihood that those involved in the military will marry and begin families at younger ages, as well. For those services in which most of the force is young, such as the Marine Corps, service members marry at younger ages and have children of younger ages. In contrast, in the Air Force and Navy the organizational culture tends to value retention of experience and more advanced technological training; thus, a greater proportion of these service members tends to be older and have older children. Overall, military-connected children are younger, with the largest group between birth and 5 years of age ( Fig. 1 ).
School and Family Life
About 13% of children of AD parents attend Department of Defense Education Activity schools, in the United States and overseas. The remainder attend civilian schools in communities surrounding military bases. Many children of AD parents are concentrated near enough to a large military base to attend schools with staff who are familiar with military culture and have an awareness of their unique needs. However, those located far away from military bases typically attend schools and live in communities that have less experience working with military families; these families face the dual challenges of decreased awareness of military cultural factors in their own communities and also of being separated from the resources near military bases. According to the Citizen Soldier Support Program, all but 12 counties in the United States were home to at least 1 of the 1.3 million Reserve members serving in 2012. Thus, a large number of military-connected children may be struggling with deployment-related family adjustments and also lacking access to base resources and military community connections.
For AD families, there are dual-service challenges for those led by 2 active-duty parents: even though there may be efforts to keep these families together, staffing needs may require them to live in different areas of the United States or even endure an overseas separation. In these cases, a difficult decision about where the children will live must be made. Single parents who are on AD face challenges inherent to single parenthood in any community, but many single civilian parents live near extended family networks, a choice not always available at the military base at which the service member is stationed. Single parents and dual-military parent families must also have a care plan in place should the need for training or deployment require parents to be away from their children for extended periods of time. Still other families, in which there is 1 AD parent and 1 civilian parent, must endure separations because of the difficult choice between allowing a child to have academic and social stability, or, because of financial constraints, preventing the family from moving with the AD member. These circumstances increase the likelihood that military families will face separations of parents from children, not only during a deployment but also at other times and for long durations.
Relocation
Over the course of a family’s time associated with the military, it is likely they will face at least 1 move outside the continental United States and the deployment of a parent. Compared with civilian families, AD military families move 2.4 times as often, with relocation occurring every 2 to 3 years, and over long distances, across state lines, or to foreign countries. By contrast, Guard and Reserve families have relocation patterns comparable with those of civilian families.
Identity and Resilience
Military families face many adversities caused by the requirements of military life, including multiple moves, changing schools and social networks, parental deployments, reintegration, and the potential dangers for injury or even death of the service member. However, these families also share a common identity of strength and sacrifice, and the special meaning of service to country is a significant resilience factor that is not only immediately protective but also probably contributes to the increased likelihood that children of service members will go on to choose a career in the military themselves. Characteristics unique to military life create both opportunities to promote resilience in children and potential challenges to healthy childhood development and behavior.
Developmental review
To better understand the impact of a significant family event, such as the deployment of a military parent, on child development, an overview of some basic concepts from both childhood and family psychological development is important.
Attachment
The work of Margaret Mahler and Mary Ainsworth emphasizes the importance of what is classically described as the mother-infant dyad, although the authors recognize that the mother can also be another caregiver who is the primary attachment figure for the child. Insecure attachment styles predict greater difficulty with peer relationships, emotional self-regulation, and school adjustment and functioning. By contrast, secure attachments arise out of the parent’s ability to discern, accept, and interpret the infant’s emotional needs. In this sense, secure attachments are born of the parent’s ability to be an external source of emotional regulation for the child. Secure attachments are protective for the child emotionally, cognitively, socially, and physically. With the potential for impact from the physical absence of a parent during later stages of infancy, and with the potential distress on the caregiving parent left at home, management of stress for the caregiving parent during the other parent’s extended absence can be an important factor in fostering secure attachments in this population. This factor prepares for greater resilience for these children as their families navigate military life. Because critical periods of development throughout childhood and adolescence arguably manifest out of the responsiveness of a parent to a child’s emotional needs, the ability of a caregiving parent to be present for the child is of considerable importance. This ability is especially important during stressful family events such as the other parent’s deployment; if there are more routine family changes, such as moving across the country; and in the event of extraordinary circumstances such as the death or significant injury of a parent during combat.
Family Functioning and Systems Theory
Functional families are characterized by parents who give children the emotional room to learn, interact with peer groups, form an identity, and acquire responsibility and maturity themselves. Military families do not differ in needing these characteristics to function well, but certain ones are of special consideration because of differences in military culture. Adaptability to external demands is essential, potentially on a repeated basis, because the military regularly requires much flexibility from its families in the form of multiple moves and multiple family member separations. Likewise, having adequate resources in the form of community and social networks, which for a military family continually change with each relocation, is vital to allow family members to thrive. Family systems theory teaches that each member of a family interacts with the other family members in ways that influence all of the relationships; likewise, military families also operate within the military as a system. Changes within individual family members (internal) and changes caused by the requirements of the military (external) all have ripple effects within the family.
The deployment cycle
Of significance to military families is the event of the service member’s deployment, requiring absence from the family for an extended period of time. Five distinct stages of deployment have been described ( Fig. 2 , Table 1 ). Each comprises a specific time frame and particular emotional challenges that the military family must successfully navigate to avoid undesirable consequences.
| Predeployment | Deployment | Sustainment | Redeployment | Postdeployment |
|---|---|---|---|---|
| Denial vs anticipation of loss | Loneliness, sadness | Establishing new supports | Excitement, increased energy | Joy and relief |
| Fears and worries | Abandonment | New responsibilities | Anticipation of return/reunion | Frustration and tension |
| Arguments | Disorganization, disorientation | Independence | Ambivalence | Changed responsibilities |
| Regressive behaviors in children | Disorientation, overwhelmed | Increased or decreased confidence | Apprehension, difficulty making decisions | Altered communication, relationships |
Predeployment begins when the service member and family learn of the impending deployment, and it is characterized by anticipation of separation. The second stage, deployment, proceeds from departure through the first month away and involves an initial adjustment reaction. Sustainment, the third stage, is endured from the first month through the next to the last month of deployment. It is a critical time for the family to create new routines and find new sources of emotional and social support from other family, friends, religious groups, or community groups. Successful navigation of this stage can help the at-home spouse build confidence and a sense of control. Children may take on new responsibilities and independence. Stage 4, redeployment, pertains to the month before a service member’s return home and typically involves feelings of excitement, but it may also be characterized by some ambivalence caused by potential loss of newfound independence and role changes. The final stage, postdeployment, begins with the homecoming of the service member and spans the subsequent 3 to 6 months. Reintegration of the service member into the family can lead to tension as responsibilities are reallocated and reunions are complicated by the possibility that family members, rules, and norms in the home have changed. This final, most critical phase also presents the opportunity for improvements in communication, relationships, and future goals that can build strength and resilience to confront future challenges.
Effects of deployment on children
Some deployment effects are generalizable to all children, whereas others are specific depending on the child’s age. Several excellent reviews have compiled the evidence in recent years. Differences that depend on each service (eg, Army, Navy, Air Force, National Guard) are more difficult to determine because of the lack of comparison studies. Although most children seem to function well during the deployment cycle, some experience negative effects that commonly occur during and/or after the deployment.
General findings across childhood
Increased Emotional and Behavioral Problems
Parental deployment seems to be associated with increased emotional and behavioral problems among military children, aged 3 to 17 years, compared with community norms, and seems to be most pronounced in older children both during and after deployment. Parenting stress and mental health status of the home caregiver seem to be associated with increases in internalizing and externalizing symptoms in their children.
Changes in Health Care Use
Retrospective studies of medical records showed deployment-related changes in health care use. For children aged 3 to 17 years, a direct correlation was found between length of deployment and increasing risk for mental health visits for acute stress reaction, adjustment disorder, depressive disorders, and behavioral disorders. In other studies examining a less broad age range, general findings included an increased rate of specialty care visits, especially those that were mental health related, but a decrease in overall health care visits. Reasons for increasing visits tended to include general mental health complaints, injuries, child maltreatment, and increased visits for preexisting mental health conditions, such as attention-deficit/hyperactivity disorder. In addition, there were increased rates of antidepressant (17.2%) and antianxiety (10%) prescriptions.
Increased Child Maltreatment
AD Army families experienced a 42% increase in the rate of child maltreatment during parental deployment, particularly rates of moderate to severe maltreatment. The level of neglect nearly doubled, whereas emotional and physical abuse seemed to decrease during deployment. Rates of severe maltreatment may be higher following a combat deployment, especially when involving alcohol use. Another study similarly found that rates of child maltreatment doubled during deployment, with increases around the times of service member departure and return; the rates were highest in children less than 4 years of age. Military families seemed to have less overall maltreatment than nonmilitary families, implying that there are certain stabilizing factors in military families at baseline that are overcome during deployment.
Decline in School Performance
The effect of deployment on school performance seems to be modest but significant. Findings for grades 3 to 11 in Department of Defense schools showed modest adverse effects in multiple academic subjects if a parent was deployed at some point during the school year, with longer deployments yielding greater effects. Another study found that elementary and middle school students had a modest but significant reduction in achievement scores when a parent had deployed for 19 months or more compared with children with less or no parental deployment.
Infants and toddlers
Increased Risk of Preterm Birth and Postpartum Depression
Spousal deployment may be associated with a higher risk of preterm birth, as well as increased risk of postpartum depression, although group prenatal care may mitigate this effect.
Disturbances of Attachment and Development
Children whose parents deployed failed measures of social-emotional functioning at twice the rate of children whose parents did not deploy. Children 0 to 47 months old showed signs of attachment strain during a parental deployment: trouble sleeping alone, not seeking comfort from the returned parent, not wanting the returned parent to leave the home, and preferring the nondeployed spouse or caregiver to the returned parent.
Increased Emotional and Behavioral Problems
Measures of internalizing behaviors, rates of sadness among children aged 3 to 5 years, and an 18% increase in stress disorder diagnosis among children aged 3 to 8 years are among the indications of problems with internalizing behaviors within this age group. Alongside these findings, externalizing behaviors were also shown by increased externalizing measures, rates of aggressive behaviors among children aged 3 to 5 years, and a 19% increase in behavior disorder diagnoses among children aged 3 to 8 years.
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