1. © Raija-Leena Punamäki 2007 Psychosocial Preventive Interventions among War Traumatized Families: Infat and Adolescent Development Raija-Leena Punamaki University of Tampere Finland

2. © Raija-Leena Punamäki 2007 Mental health problems (MHP) & communal responses in military violence Acute symptoms of depression, aggression, PTSD & dissociation Children at risk: wounded, homeless, poor, earlier trauma, family problems, low threshold temperement, poor coping A) INTERVENTION MHP Symptom-focused treatment B) PREVENTION MHP Resíliency groups Psychoeducational Family involvement Children & families exposed to trauma with no special risk factors & vulnerability C) PROMOTION MH Promotion of healthy conditions: School, healthcare, participation National politics, strategies

3. © Raija-Leena Punamäki 2007 Gaza Community Mental Health Programme: Example of two preventive interventions ’Clients’ view: Mothers: Biology does not protect Parents: Worry about adolescent’s future I Enhancing healthy interaction with mother-child dyads in extreme destruction II Trauma & Resiliency focused intervention with adolescents

4. © Raija-Leena Punamäki 2007

5. Developmental ’tasks’ during the first year of life 0-6 mo Integration of sensories: eye, move Emotional attunement & arousal 6-12mo Attachment style & Mother-child int.  Secure  Insecure-avoidant  Insecure-Ambivalent  Disorganized

6. © Raija-Leena Punamäki 2007 Attachment style & in child development Emotions  Recognition own & others feelings  Regulation of affect  Expressing emotions, syncrony Cognitions  memory: episodic, semantic & procedural  thinking, causal relations & attribution Social relations  Thurst in self & others, support seeking  Group membership, sharing

7. © Raija-Leena Punamäki 2007 Impact life threat on attachment Main early risks: 1) Fear in mother’s eyes 2) Maternal PSTD-intrusive & dissociative states of mind Strong correlation between human interaction & sensory, psychological and physiological development Attachment problems: either too little or too much emotional self-regulation:’inhibited vs disinhibited’ Insufficient recognition of social cues Long-term elevated cortisol level (HPA) refer to constantly high arousal and stress

8. © Raija-Leena Punamäki 2007 Interventios: What can be changed? How? When? By whom? Neurofysiology Sensomotor Cognitive Emotional Social stress regulation brain specification coordination* complexity language attention memory problem solving emotion recognition emotional expression empathy friendship Experiences Maturation

9. © Raija-Leena Punamäki 2007 Mater-child interaction in trauma & life threat Social support Maternal mood (Depressio & Anxiety) Mother-child interaction Representations of own childhood TRAUMA & LIFE THREAT Child temperament Infant behavior: Crying, fussing Infant sleeping patterns Attachment style Child developement: Emotional Cognitive Social Psychofysiological Sensory integration Emotion regulation Maternal sensitivity

10. © Raija-Leena Punamäki 2007 Developmental ’tasks’ during the adolescence Early adolescence 11-13 years Peer-group & friends important Temp. regression of emotional accuracy High sophistication in thinking & solving Adolescence 14-17 years Growth spurts Intimate relationships High moral sophistication Temporary increase in aggression

11. © Raija-Leena Punamäki 2007

12. Combine interventions & preventions Symptom management & trauma healing –deals with information, understanding & integration –procedes pre-designed order –addresses painful memories, symptoms and coping Resilience-building -groups –deals with fantasy –adresses resources –addresses problems directly only by members initiative Therapy –groups & individual –addresses problems and resources –processoriented, -not pre-designed

13. Accumulation of problems and their interaction in adolescence Prospect of future Personality & meaning Education: school dropout Antisocial behavior Peer & parent relations Self efficacy Mental & material resources Depressive disorders Stress Traumatic events © Raija-Leena Punamäki 2007

14. Conclusion: War trauma can be healed Apply & tailor ’manualized, evidence- based preventive interventions’ on well-defined problem Developmental science: sensitivity period Intervention & Prevention science: Mode & focus of intervention Be aware of philosophy