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Supporting Development During Military Deployment and After April 2018
Katherine A Trier1, Demetra Pappas1, Bryan Bovitz2
1Division of Developmental Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Insights
This case highlights the complex needs of a child diagnosed with autism spectrum disorder (ASD), global developmental delay, and ADHD, compounded by significant family trauma and a father
Area of Science:
- Pediatric developmental and behavioral health.
- Family systems and trauma-informed care.
- Military family well-being and reintegration.
Background:
- A 6-year-old child diagnosed with autism spectrum disorder (ASD), global developmental delay, and attention deficit hyperactivity disorder (ADHD) presents unique care challenges.
- The child's father is a combat veteran experiencing psychological and physical health issues, struggling with single-parent responsibilities after his wife's sudden death.
- The family faces compounded stressors including parental grief, military service-related trauma, and the child's developmental and behavioral needs.
Observation:
- The child's father, a first-time primary caregiver, feels unprepared and overwhelmed, lacking knowledge of child development due to frequent military deployments.
- The father reports isolation and difficulty coping with his own combat-related trauma and chronic pain.
- The child's developmental delays and behavioral atypicalities were noted after the father assumed full-time caregiving responsibilities.
Findings:
- A comprehensive, integrated approach is crucial, addressing the child's ASD, global developmental delay, and ADHD concurrently.
- Trauma-informed care strategies are essential for both the child and the father, acknowledging the impact of the mother's death and the father's combat experiences.
- Support for the father's well-being, including mental health services and caregiver education, is paramount for effective parenting and child outcomes.
Implications:
- Primary care practices must be equipped to identify and manage complex cases involving developmental disorders, trauma, and parental challenges.
- Emphasizing family-centered interventions, including parental support and education, is vital for improving child development and family functioning.
- Interdisciplinary collaboration among pediatricians, behavioral specialists, and mental health professionals is key to providing holistic care for such vulnerable families.
Case:
Ryan is a 6-year-old child new to your primary care practice after relocating from out of state with his father and younger sister. Ryan's grandmother recently expressed concerns about Ryan's social skills and behavior. He was subsequently diagnosed by a developmental and behavioral pediatrician with autism spectrum disorder, global developmental delay, and attention deficit hyperactivity disorder. At your first visit with Ryan, his father provides the following history: When Ryan was 3 years old, he was living with his mother and infant sister while his father was serving his fourth tour of duty with the marines in Afghanistan. One night, while Ryan was sleeping in bed with his mother, she died suddenly from a pulmonary embolism. Ryan's father was then called home from Afghanistan to take care of the children.Ryan's father explains that this was his first time serving as a primary caregiver for any prolonged period. He felt overwhelmed and unprepared, both cognitively and emotionally, to return from a combat zone and assume full-time, single-parent responsibilities. Ryan's father admitted knowing little about child development and had not had sustained interactions with his own children because of frequent deployments. He did not appreciate the delays and atypicalities in Ryan's development until he moved back home with his own mother and she expressed concerns. Ryan's father had his own psychological, emotional, and physical challenges from participating in active combat, including chronic pain in his shoulder from multiple gunshot wounds. Despite moving back home to be close to his family, Ryan's father admits feeling isolated and reports that "no one knows what it feels like."How would you provide unique support to Ryan and his family? What treatment modalities are particularly important to emphasize?
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