Clinical Child and Family Psychology Review

, Volume 6, Issue 4, pp 275–292 | Cite as

Consequences of Child Exposure to War and Terrorism

Article

Abstract

Acts of war and terrorism are increasingly prevalent in contemporary society. Throughout history, weaponry has become more efficient, accurate, and powerful, resulting in more devastation and loss of human life. Children are often overlooked as victims of such violence. Around the world, children are exposed to violence in multiple forms, frequently developing traumatic stress reactions. Such reactions are best understood within the context of social–emotional and cognitive development, as children respond differently to the stress of violence depending on their developmental level. Furthermore, the violence of war and terrorism often results in a multitiered cascade of negative life events including loss of loved ones, displacement, lack of educational structure, and drastic changes in daily routine and community values. These numerous losses, challenges, and stresses affect children's brains, minds, and bodies in an orchestrated whole-organism response. This paper describes these effects, synthesizing the current state of research on childhood traumatic stress reactions from the fields of neuroscience, clinical psychology, and pediatric diagnostic epidemiology.

war terrorism trauma child development 

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References

  1. Adjukovic, M. (1996). Mothers' perception of their relationship with their children during displacement: A six month follow-up. Child Abuse Review, 5, 34-49.Google Scholar
  2. Adjukovic, M., & Adjukovic, D. (1993). Psychological well-being of refugee children. Child Abuse and Neglect, 17, 843-854.Google Scholar
  3. Adjukovic, M., & Adjukovic, D. (1998). Impact of displacement on the psychological well being of refugee children. International Review of Psychiatry, 10, 186-195.Google Scholar
  4. Adjukovic, M., & Zic, V. (1997, September). Prevention of delinquent experience in childhood: Croatian experience. Paper presented at the 7th European Conference on Psychology and Law, Stockholm.Google Scholar
  5. Arroyo, W., & Eth, S. (1996). Traumatic stress reactions and post-traumatic stress disorder (PTSD). In R. Apfel & B. Simon (Eds.), Minefields in the heart: The mental health of children in war and communal violence. New Haven, CT: Yale University Press.Google Scholar
  6. Baker, A. (1991). Psychological response of Palestinian children to environmental stress associated with military occupation. Journal of Refugee Studies, 4, 237-247.Google Scholar
  7. Bandura, A. (1973). Aggression: A social learning analysis. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
  8. Bandura, A. (1978). Social learning theory of aggression. Journal of Communications, 28, 12-29.Google Scholar
  9. Beardslee, W. R., Salt, P., Versage, E. M., & Gladstone, T. R. (1997). Sustaining change in parents receiving preventive interventions for families with depression. American Journal of Psychiatry, 154, 510-515.Google Scholar
  10. Blakeney, P., Herndon, D., Desai, M., Beard, S., & Wales-Sears, P. (1988). Long-term psychological adjustment following burn injury. Journal of Burn Care and Rehabilitation, 9, 661-665.Google Scholar
  11. Blakeney, P., & Meyer, W. (1995). Psychosocial recovery of burned patients and reintegration into society. In D. N. Herndon (Ed.), Total burn care(pp. 556-563). London: W. B. Saunders.Google Scholar
  12. Blakeney, P., Meyer, W., Levin, H., Ledoux, J., Moore, P., Robert, R., et al. (1996). Psychosocial resilience may require extraordinary family effort: A comparison of pediatric burn survivors, head injured children, and their families. Proceedings of the American Burn Association, 28, 29-37.Google Scholar
  13. Blakeney, P., Meyer, W., Moore, P., Murphy, L., Broemeling, L., Robson, M., et al. (1993). Psychosocial sequelae of pediatric burns involving 80% or greater total body surface area. Journal of Burn Care and Rehabilitation, 14, 684-689.Google Scholar
  14. Blakeney, P., Portman, S., & Rutan, R. (1990). Familial values as factors influencing long-term psychological adjustment of children following severe burn injury. Journal of Burn Care and Rehabilitation, 11, 472-475.Google Scholar
  15. Blakeney, P., Robert, R., & Meyer, W. J. (1989). Psychological and social recovery of children disfigured by physical trauma: Elements of treatment supported by empirical data. International Review of Psychiatry, 10, 196-200.Google Scholar
  16. Bordlieri, J. E., Solodky, M. L., & Mikos, K. A. (1985). Physical attractiveness and nurses: Perceptions of pediatric patients. Nursing Research, 34, 24-26.Google Scholar
  17. Bremner, J. D., Randall, P., Scott, T. M., & Bronen, R. A. (1997). MRI-based measurement of hippocampal volume in PTSD related to childhood physical and sexual abuse: A preliminary report. Biological Psychiatry, 41, 23-32.Google Scholar
  18. Bremner, J. D., Randall, P., Scott, T. M., Capelli, S., Delaney, R., McCarthy, G., et al. (1995). Deficits in short-term memory in adult survivors of childhood abuse. Psychiatry Research, 59, 97-107.Google Scholar
  19. Bronfenbrenner, U. (1988). Interacting systems in human development: Research paradigms: Present and future. In N. Bolger & A. Caspi (Eds.), Persons in context: Developmental processes(pp. 25-49). London: Cambridge University Press.Google Scholar
  20. Cash, T. F. (1990). The psychology of physical appearance: Aesthetics, attributes, and images. In T. F. Cash & I. T. Pruzinsky (Eds.), Body images: Development, deviance, and change(pp. 51-79). New York: Guilford.Google Scholar
  21. Castro-Alamancos, M. A., & Connors, B. W. (1996). Short-term plasticity of a thalamocortical pathway dynamically modulated by behavioral state. Science, 272, 274-276.Google Scholar
  22. Cicchetti, D., & Toth, S. L. (1995). A developmental psychopathology perspective on child abuse and neglect. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 541-565.Google Scholar
  23. Cooley-Quille, M., Turner, S., & Beidel, D. (1995). Emotional impact of children's exposure to community violence: A preliminary study. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 1362-1368.Google Scholar
  24. Coster, W. J., Gersten, M. S., Beeghly, M., & Cicchetti, D. (1989). Communicative functioning in maltreated toddlers. Developmental Psychology, 25, 777-793.Google Scholar
  25. Courchesne, E., Chisum, H., & Townsend, J. (1994). Neural activity-dependent brain changes in development: Implications for psychopathology. Development and Psychopathology, 6, 697-722.Google Scholar
  26. DeBellis, M. D. (1997). Posttraumatic stress disorder and acute stress disorder. In R. T. Ammerman & M. Hersen (Eds.), Handbook of prevention and treatment with children and adolescents: Intervention in the real world context(pp. 455-494). New York: Wiley.Google Scholar
  27. DeBellis, M. D. (2002). Abuse and ACTH response to corticotropin releasing factor. American Journal of Psychiatry, 159, 157-161.Google Scholar
  28. Dell Orto, A. E. (1991). Coping with the enormity of illness and disability. In R. P. Marinelli & A. E. Dell Orto (Eds.), The psychological and social impact of disability(pp. 333-335). Berlin: Springer.Google Scholar
  29. Dodge, K. A. (1993). Social-cognitive mechanisms in the development of conduct disorder and depression. Annual Review of Psychology, 44, 559-584.Google Scholar
  30. Dodge, K. A., Bates, J. E., & Pettit, G. S. (1990). Mechanisms in the cycle of violence. Science, 250, 1678-1683.Google Scholar
  31. Druzic, O., Grl, M., Kletecki, M., & Adjukovic, M. (1997). Meeting the needs of children in resettlement process in Hvatska Kostajnica. Proceedings of the International Conference on Trauma Recovery Training: Lessons Learned, Croatia, 61, 97-104.Google Scholar
  32. Dzepina, M., Prebeg, Z., Juresa, V., Bogdan-Matjan, K., Brkljacic, D., Erdelj-Stivicic, B., et al. (1992). Suffering of Croatian school children during war. Croatian Medical Journal, 33, 40-44.Google Scholar
  33. Famularo, R., Kinscherff, R., & Fenton, T. (1992). Psychiatric diagnoses of maltreated children: Preliminary findings. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 863-867.Google Scholar
  34. Flisher, A. J., Kramer, R. A., Hoven, C. W., & Greenwald, S. (1997). Psychosocial characteristics of physically abused children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 123-129.Google Scholar
  35. Fox, L., Long, S. H., & Anglois, A. (1988). Patterns of language comprehension deficit in abused and neglected children. Journal of Speech and Hearing Disorders, 53, 239-244.Google Scholar
  36. Galante, R., & Foa, D. (1986). An epidemiological study of psychic trauma and treatment effectiveness for children after a natural disaster. Journal of the American Academy of Child and Adolescent Psychiatry, 25, 357-363.Google Scholar
  37. Galea, S., Ahern, J., Resnick, H., Kilpatrick, D., Bucuvalas, M., Gold, J., et al. (2002). Psychological sequelae of the September 11 terrorist attacks in New York City. New England Journal of Medicine, 346, 982-987.Google Scholar
  38. Garbarino, J., Kostelny, K., & Dubrow, N. (1991). No place to be a child: Growing up in a war zone. Lexington, MA: Lexington Books.Google Scholar
  39. Gilligan, S. G., & Bower, G. H. (1983). Reminding and mood-congruent memory. Bulletin of the Psychonomic Society, 21, 431-434.Google Scholar
  40. Glaser, D. (2000). Child abuse and neglect and the brain—A review. Journal of Child Psychology and Psychiatry, 41, 97-116.Google Scholar
  41. Glod, C. A., Teicher, M. H., & Hartman, C. R. (1997). Increased nocturnal activity and impaired sleep maintenance in abused children. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1236-1243.Google Scholar
  42. Godden, D. R., & Baddeley, A. D. (1975). Context-dependent memory in two natural environments: On land and underwater. British Journal of Psychology, 66, 325-331.Google Scholar
  43. Green, A. H. (1997). Physical abuse of children. In J. Weiner (Ed.), American Academy of Child and Adolescent Psychiatry textbook of child and adolescent psychiatry(pp. 17-38). Washington, DC: American Psychological Association.Google Scholar
  44. Grguric, J., & Hirsl-Hecej, V. (1993). Program for providing minimum nutritional and health care requirements for children in Croatia. Zagreb, Croatia: Committee for Coordination of Relief and Health Care for Children in Exceptional Circumstances.Google Scholar
  45. Gunnar, M. (1998). Quality of early care and buffering of neuroendocrine stress reactions: Potential effects on the developing human brain. Preventative Medicine, 27, 208-211.Google Scholar
  46. Heim, C., Newport, D. J., & Heit, S. (2000). Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood. JAMA, 284, 592-597.Google Scholar
  47. Herrenkohl, R. C., Egolf, B. P., & Herrenkohl, E. C. (1997). Preschool antecedents of adolescent assaultive behavior: A longitudinal study. American Journal of Orthopsychiatry, 67, 422-432.Google Scholar
  48. Horowitz, M., Wilner, N., & Alvarez, W. (1979). Impact of Event Scale: A measure of subjective stress. Psychosomatic Medicine, 41, 209-218.Google Scholar
  49. James, B. (1994). Handbook for treatment of attachment-trauma problems in children. New York: Free Press.Google Scholar
  50. Kagan, J. (1984). The nature of the child. New York: Basic Books.Google Scholar
  51. Kagan, J. (1998). Three seductive ideas. Boston: Harvard University Press.Google Scholar
  52. Kandel, E. W. (2001). The molecular biology of memory storage: A dialogue between genes and synapses. Science, 294, 1030-1038.Google Scholar
  53. Kaplan, S. J., Pelcovitz, D., & Labruna, V. (1999). Child and adolescent abuse and neglect research: A review of the past 10 years. Part I: Physical and emotional abuse and neglect. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1214-1222.Google Scholar
  54. Kaplan, S. J., Pelcovitz, D., Salzinger, S., Weiner, M., Mandel, F. S., Lesser, M. L., et al. (1998). Adolescent physical abuse: Risk for adolescent psychiatric disorders. American Journal of Psychiatry, 155, 954-959.Google Scholar
  55. Keane, T. M., Kolb, L. C., & Kaloupek, D. G. (1998). Utility of psychophysiology measurement in the diagnosis of posttraumatic stress disorder: Results from a department of Veteran's Affairs cooperative study. Journal of Consulting and Clinical Psychology, 66, 914-923.Google Scholar
  56. Klimes-Dougan, B., & Kistner, J. (1990). Physically abused preschoolers' responses to peers' distress. Developmental Psychology, 26, 599-602.Google Scholar
  57. Kovacs, M. (1981). Rating scale to assess depression in school-aged children. Acta Peadopsychiatrica, 46, 305-315.Google Scholar
  58. Krystal, H. (1968). Massive psychic trauma. New York: International Universities Press.Google Scholar
  59. Kuterovac, G., Dyregrov, A., & Stuvland, R. (1994). Children in war: A silent majority under stress. British Journal of Medical Psychology, 67, 363-375.Google Scholar
  60. Langlois, J. H., & Downs, A. D. (1979). Peer relations as a function of physical attractiveness: The eye of the beholder or behavioral reality? Child Development, 50, 409-418.Google Scholar
  61. LeDoux, J., Blakeney, P., Meyer, W., & Herndon, D. (1994). Relationships between parental emotional states, family environment, and the behavioral adjustment of pediatric burn survivors. Proceedings of the American Burn Association, 26, 96-107.Google Scholar
  62. LeDoux, J. E., Romanski, L., & Xagoraris, A. (1989). Indelibility of subcortical emotional memories. Journal of Cognitive Neuroscience, 1, 238-243.Google Scholar
  63. Lemieux, A. M., & Coe, C. L. (1995). Abuse-related posttraumatic stress disorder: Evidence for chronic neuroendocrine activation in women. Psychosomatic Medicine, 57, 105-115.Google Scholar
  64. Lewis, D. O. (1992). From abuse to violence: Psychophysiological consequences of maltreatment. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 383-391.Google Scholar
  65. Lewis, D. O. (1996). Development of the symptom of violence. In M. Lewis (Ed.), Child and adolescent psychiatry: A comprehensive textbook. Baltimore: Williams and Wilkins.Google Scholar
  66. Livingston, R., Lawson, L., & Jones, J. G. (1993). Predictors of self-reported psychopathology in children abused repeatedly by a parent. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 948-953.Google Scholar
  67. Lopizic, J. (1995, May). Neka iskustva u radu s djecom povratnicima na dubrovackom podrucju[Some experiences with repatriated children in Dubrovnik region]. Paper presented at the 3rd Annual Conference of Croatian Psychologists, Bizovac.Google Scholar
  68. Lyons-Ruth, K., Connell, D. B., & Grunebaum, H. (1990). Infants at social risk: Maternal depression and family support services as mediators of infant development and security of attachment. Child Development, 61, 85-98.Google Scholar
  69. Mattson, A. (1977). Long-term physical illness in childhood: A challenge to psychosocial adaptation. In R. H. Moos (Ed.), Coping with physical illness(pp. 183-199). New York: Plenum.Google Scholar
  70. McCallin, M., & Fozzard, S. (1990). The impact of traumatic events on the psychological well-being of Mozambican refugee women and children. Geneva: International Catholic Child Bureau.Google Scholar
  71. McEwen, B. S., & Magarinos, M. (1997). Stress effects on morphology and function of the hippocampus. In R. Yehuda & A. C. McFarlane (Eds.), Psychobiology of posttraumatic stress disorder(pp. 271-284). New York: New York Academy of Sciences.Google Scholar
  72. McFadyen, R. G., & Kitson, W. J. H. (1996). Language comprehension and expression among adolescents who have experienced childhood physical abuse. Journal of Child Psychology and Psychiatry, 37, 551-562.Google Scholar
  73. Meyer, W., Blakeney, P., Ledoux, J., & Herndon, D. N. (1995). Diminished adaptive behaviors among pediatric survivors of burns. Journal of Burn Care and Rehabilitation, 16, 511-518.Google Scholar
  74. Meyer, W., Blakeney, P., Moore, P., Murphy, L., Robson, M., & Herndon, D. N. (1994). Parental well-being and behavioral adjustment of pediatric survivors of burns. Journal of Burn Care and Rehabilitation, 15, 62-68.Google Scholar
  75. Meyer, W., Doctor, M., Robert, R., Murphy, L., McShan, S., & Blakeney, P. (1997). Psychosocial outcome of 327 pediatric burn survivors. Proceedings of the American Burn Association, 29, 2-13.Google Scholar
  76. Milgram, N. A. (1982). War related stress in Israeli children and youth. In L. Goldberg & S. Brenitz (Eds.), Handbook of stress: Theoretical and clinical aspects(pp. 656-676). New York: Free Press.Google Scholar
  77. Milgram, R. M., & Milgram, N. A. (1976). The effects of the Yom Kuppur war on the anxiety level in Israeli children. Journal of Psychology, 34, 107-113.Google Scholar
  78. Moore, P., Blakeney, P., Broemeling, L., Portman, S., Herndon, D. N., & Robson, M. (1993). Psychological adjustment following childhood burn injuries predicted by personality traits. Journal of Burn Care and Rehabilitation, 14, 80-82.Google Scholar
  79. Moro, L. J., & Vidovic, V. (1992). Psihicke promjene u djece i odraslih prognanika [Psychological changes in displaced children and adults]. In E. Klain (Ed.), Ratna psihologija i psihijatrija[War psychology and psychiatry] (pp. 192-171). Zagreb, Croatia: Ratni stozer Republike Hrvatske.Google Scholar
  80. Nachmias, M., Gunnar, M., Mangelsdorf, S., & Parritz, R. H. (1996). Behavioral inhibition and stress reactivity: The moderating role of attachment security. Child Development, 67, 508-522.Google Scholar
  81. Nelson, C. A., & Carver, L. J. (1998). The effects of stress and trauma on brain and memory: A view from developmental cognitive neuroscience. Development and Psychopathology, 10, 793-809.Google Scholar
  82. Osofsky, J. (1995). The effects of exposure to violence on young children. American Psychologist, 50, 782-788.Google Scholar
  83. Pelcovitz, D., Kaplan, S., Goldenberg, B., & Weinblatt, M. (1994). Post-traumatic stress disorder in physically abused adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 305-312.Google Scholar
  84. Perez, C. M., & Widom, C. S. (1994). Childhood victimization and long-term intellectual and academic outcomes. Child Abuse and Neglect, 18, 617-624.Google Scholar
  85. Perry, B. D. (1999). The memories of states: How the brain stores and retrieves traumatic experience. In J. Goodwin & R. Attias (Eds.), Splintered reflections: Images of the body in trauma(pp. 9-38). New York: Basic Books.Google Scholar
  86. Perry, B. D. (2001). The neurodevelopmental impact of violence in childhood. In D. Schetky & E. Benedek (Eds.), Textbook of child and adolescent forensic psychiatry(pp. 221-238). Washington, DC: American Psychiatric Press.Google Scholar
  87. Perry, B. D., & Pollard, R. (1998). Homeostasis, stress, trauma and adaptation—A neurodevelopmental view of childhood trauma. Child and Adolescent Psychiatric Clinics of North America, 7, 33-51.Google Scholar
  88. Perry, B. D., Pollard, R. A., Blakley, T. L., Baker, W. L., & Vigilante, D. (1995) Childhood trauma, the neurobiology of adaptation, and “use-dependent” development of the brain: How “states” become “traits.” Infant Mental Health Journal, 16, 271-291.Google Scholar
  89. Pfefferbaum, B., Nixon, S. J., Tucker, P. M., Tivis, R. D., Moore, V. L., Gurwitch, R. H., et al. (1999). Posttraumatic stress responses in bereaved children after the Oklahoma City bombing. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1372-1379.Google Scholar
  90. Phillips, R. G., & LeDoux, J. E. (1992). Differential contribution of amygdala and hippocampus to cued and contextual fear conditioning. Behavioral Neuroscience, 106, 274-285.Google Scholar
  91. Pynoos, R., & Nader, K. (1993). Issues in the treatment of posttraumatic stress in children and adolescents. In J. Wilson & B. Raphael (Eds.), International handbook of traumatic stress syndromes. New York: Plenum.Google Scholar
  92. Ressler, E. M., Boothby, N., & Steinbock, D. J. (1988). Unaccompanied children. New York: Oxford University Press.Google Scholar
  93. Sapolsky, R. (1996). Why stress is bad for your brain. Science, 273, 749-750.Google Scholar
  94. Schlenger, W. E., Caddell, J. M., Ebert, L., Jordan, B. K., Rourke, K. M., Wilson, D., et al. (2002). Psychological reactions to terrorist attacks: Findings from the National Study of Americans' Reactions to September 11. JAMA, 288, 581-588.Google Scholar
  95. Schuster, M. A., Stein, B. D., Jaycox, L. H., Collins, R. C., Marshall, G. N., Elliott, M. N., et al. (2001). A national survey of stress reactions after the September 11, 2001 terrorist attacks. New England Journal of Medicine, 345, 1507-1512.Google Scholar
  96. Semple, W. E., Goyer, P. F., McCormick, R., & Compton-Toth, B. (1996). Attention and regional cerebral blood flow in posttraumatic stress disorder patients with substance abuse histories. Psychiatric Research in Neuroimaging, 67, 17-28.Google Scholar
  97. Shaw, J. A. (2000). Children, adolescents and trauma. Psychiatric Quarterly, 71, 227-243.Google Scholar
  98. Shin, L. M., McNally, R. J., Kosslyn, S. M., Thompson, W. L., Rauch, S. L., Alport, N. M., et al. (1999). Regional cerebral blood flow during script-driven imagery in childhood sexual abuse related PTSD: A PET investigation. American Journal of Psychiatry, 156, 575-584.Google Scholar
  99. Singer, W. (1995). Development and plasticity of cortical processing architectures. Science, 270, 758-764.Google Scholar
  100. Talbot, J. A. (2001, October 26). Look behind classic symptoms to spot PTSD in affected kids. Clinical Psychiatry News, p. 12.Google Scholar
  101. Terr, L. C. (1983). Chowchilla revisited: Post-traumatic child's play. Journal of the American Academy of Child and Adolescent Psychiatry, 20, 741-760.Google Scholar
  102. Terr, L. C. (1991). Childhood traumas: An outline and overview. American Journal of Psychiatry, 148, 10-20.Google Scholar
  103. Terr, L. C. (1996). Acute responses to external events and posttraumatic stress disorder. In M. Lewis (Ed.), Child and adolescent psychiatry: A comprehensive textbook. Baltimore: Williams and Wilkins.Google Scholar
  104. Vondra, J. I., Barnett, D. E., & Cicchetti, D. (1990). Self-concept, motivation, and competence among preschoolers from maltreating and comparison families. Child Abuse and Neglect, 14, 525-532.Google Scholar
  105. Widom, C. S. (1989). Child abuse, neglect, and adult behavior. Criminology, 27, 251-271.Google Scholar
  106. Winnicott, D. W. (1992). Deprivation and delinquency. London: Routledge.Google Scholar
  107. Wodarski, J. S., Kurtz, P. D., Gaudin, J. M., Jr., & Howing, P. T. (1990). Maltreatment and the school age child: Major academic, socioemotional, and adaptive outcomes. Social Work, 35, 581-589.Google Scholar
  108. Yeager, C. A., & Lewis, D. O. (2000). Mental illness, neuropsychologic deficits, child abuse, and violence. Child and Adolescent Psychiatric Clinics of North America, 9, 793-813.Google Scholar
  109. Yehuda, R., Spertus, I., & Golier, J. (2001). Relationship between childhood traumatic experiences and PTSD in adults. In S. Eth (Ed.), PTSD in children and adolescents(pp. 117-146). Washington, DC: American Psychiatric Publishing.Google Scholar
  110. Zivcic, I. (1993). Emotional reactions of children to war stress in Croatia. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 709-713.Google Scholar

Copyright information

© Plenum Publishing Corporation 2003

Authors and Affiliations

  1. 1.Department of Psychiatry and Behavioral SciencesChildren's National Medical CenterWashingtonDistrict of Columbia
  2. 2.Department of Psychiatry, Behavioral Sciences and PediatricsGeorge Washington University School of MedicineWashingtonDistrict of Columbia
  3. 3.Department of PsychologySt. Mary's College of Maryland
  4. 4.Department of Psychiatry and Behavioral Sciences, Children's National Medical CenterInternational Center to Heal Our ChildrenWashingtonDistrict of Columbia

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