487

The Impact of Deployment on Military Families and Children

Chapter 30

THE IMPACT OF DEPLOYMENT ON 

MILITARY FAMILIES AND CHILDREN

SIMON PINCUS, MD*; BARBARA LEINER, MSW, LCSW-C†; NANCY BLACK, MD‡; and TANGENEARE 

WARD SINGH, MD§

INTRODUCTION

THE DEPLOYMENT CYCLE

Predeployment

Deployment

Sustainment

Late Deployment

Postdeployment

EFFECTS OF DEPLOYMENT ON SPOUSES

CHILDREN’S DEVELOPMENTAL RESPONSES DURING DEPLOYMENT

Infants

Toddlers

Preschoolers

School-Age Children

Adolescents

INTERGENERATIONAL TRANSMISSION OF THE EFFECTS OF WAR AND 

COMBAT TRAUMA

SUMMARY

ATTACHMENT: RESOURCES FOR MILITARY FAMILIES

*Colonel (Retired), US Army; Clinical Director, Department of Mental Health, McChord Medical Clinic, 690 Barnes Boulevard, Joint Base Lewis-McChord 

(McChord Field), Washington 98438; formerly, Chief, Inpatient Psychiatry, Madigan Army Medical Center, Tacoma, Washington 

†

Psychiatric Social Worker, Department of Child Psychiatry, Walter Reed Army Medical Center, Borden Pavilion, 6900 Georgia Avenue NW, Washington, 

DC 20307-5001; formerly, Clinical Case Manager, Department of Child Psychiatry, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland

‡

Colonel, Medical Corps, US Army; Training and Program Director, National Capital Consortium of Child and Adolescent Psychiatry Fellowships, 

Department of Psychiatry, Walter Reed Army Medical Center, Borden Pavilion, 6900 Georgia Avenue NW, Washington, DC 20307-5001

§

Major, Medical Corps, US Army; Department of Behavioral Health, Blanchfield Army Community Hospital, 650 Joel Drive, Fort Campbell, Kentucky 

42223 
488

Combat and Operational Behavioral Health

“Deployment” is the term used when military personnel leave their usual daily workstations to train 

for or to perform a mission. Missions vary in length 

and range from training to humanitarian assistance 

to combat. Deployment has an effect on the service 

member, the member’s unit, the units that remain to 

carry on with existing tasks, and the affiliated support 

systems in the community as well as the member’s 

family. With an increased number of married military 

service members, deployment affects a growing community of spouses and children, both on and off base. 

Whether service members are single or married, their 

parents, siblings, and other relatives are frequently 

part of an extended family network that is affected by 

deployment and its outcome. This chapter addresses 

the complex issues faced by the military family when 

a service member leaves the home base to perform 

the mission of war. It also provides a list of resources 

available to military service members and their families 

(see Attachment).

In 1994, Peebles-Kleiger and Kleiger1

 wrote about 

reintegration stress in families with members returning 

from Operations Desert Shield/Storm (ODS/S). They 

described two versions of this stress: (1) Logan’s seven 

phases of adjustment and (2) a four-stage version of 

emotional adjustment based on the Kubler-Ross model 

of grief.1(pp176–177) In a report on the emotional cycle of 

deployment following the Gulf War and during the 

rotations to Bosnia and Kosovo, Pincus et al2 utilized 

these models to identify five stages: (1) predeployment, 

(2) deployment, (3) sustainment, (4) late deployment 

(referred to as “redeployment” in the original online article), and (5) postdeployment. Simon Pincus, MD, is an 

Army psychiatrist at McChord Medical Clinic (Madigan 

Army Medical Center) in Tacoma, Washington. He and 

his colleagues have continued using this approach as 

they educate families and communities during Operation Enduring Freedom (OEF), Operation Iraqi Freedom 

(OIF), and Operation Noble Eagle (ONE) engagements. 

Their goal is to sustain health and function in all family 

members during the stress of deployment.

In ODS/S (1990–1991), 645,000 troops were deployed to the war zone, including 228,000 National 

Guard and reserve forces that were brought onto 

active duty.3(p273) OIF and OEF have included an even 

wider variety and greater number of military service 

members4(p233): activated reserve and National Guard 

units and personnel, as well as individual augmentees and ready reserve personnel. During the Balkans 

engagements service members were occasionally sent 

on second deployments and multiple tours (some 

units have had three or four deployments). Longer 

tours (particularly for the Army) to a combat theater 

have become common during OIF and OEF. Soldiers 

who have already endured physical and psychological injuries—including posttraumatic stress disorder 

(PTSD)—are being returned to combat conditions. The 

broader involvement of service personnel, who are 

deployed more frequently and for longer tours of duty, 

likely increases the impact of the mission on military 

as well as civilian families and communities. 

In many cases during ODS/S, families were less 

prepared for mobilization and war5(p442) than families 

in today’s readiness climate. Many families of ODS/S 

military personnel were unfamiliar with the larger 

military system of demands, benefits, and supports 

that exists for the active duty member and beneficiary. Foreign-born or non-English–speaking spouses, 

another subset of military families facing unique circumstances, may be less capable or willing to access 

available resources.6(p78)

School enrollment records provide one example of 

the size of deployment impact on military children. In 

2004, Lamberg7 reported in the Journal of the American 

Medical Association that 191,000 children of soldiers 

were enrolled in public schools in approximately 35 

school districts near military posts around the United 

States. In addition to this number, the Department of 

Defense reported approximately 104,000 children enrolled in preschool through 12th grade at DoD schools 

in seven US states, Guam, and Puerto Rico, and in 13 

foreign countries.7

To date, national and local community support of 

troops has been consistently positive in OIF, OEF, and 

ONE. Although there are differing political views and 

increasing criticism about the execution of the war in 

Iraq, the nation as a whole has been able to separate 

these issues from the role of military service members 

and to convey support for them and their families. This 

broad community support creates a positive environment for military families, which in turn results in less 

isolation and greater overall family resiliency.8(p1285)

The Deployment Cycle

Each stage of deployment involves emotional and 

organizational elements that affect both individual 

service members and their families (Figure 30-1). Any 

impending deployment introduces uncertainty, even 

for previously deployed and experienced service members. Despite ongoing training, ambiguity likely exists 

INTRODUCTION
489

The Impact of Deployment on Military Families and Children

• Anticipation of loss vs denial

• Train up; long hours away

• Getting affairs in order

• Mental and physical distance

• Arguments

Stage 1: Predeployment

Time frame: variable

• Mixed emotions/relief

• Disoriented/overwhelmed

• Numb, sad, alone

• Sleep difficulty

• Security issues

Stage 2: Deployment

Time frame: first month, time through 

staging, embarkation, and settling in to 

mission

• New routines established

• New sources of support

• Feeling more in control

• Independence

• Confidence (“I can do this”)

Stage 3: Sustainment

Time frame: month 2 through near end

• Anticipation of homecoming

• Excitement

• Apprehension

• Burst of energy/”nesting”

• Difficulty making decisions

Stage 4: Late Deployment

Time frame: penultimate month to end

• Honeymoon period

• Loss of independence

• Need for “own” space

• Renegotiating routines

• Reintegrating into family

Stage 5: Postdeployment

Time frame: 3 to 6 months after return 

home

Figure 30-1. Common emotional rections to each stage of 

deployment.

TABLE 30-1

NEGATIVE EMOTIONAL AND BEHAVIORAL 

CHANGES IN CHILDREN DURING DEPLOYMENT

Age Behaviors Emotions Remedies

Infants: 

< 1 y

Refusing to 

eat

Listlessness Support from 

parent, pediatrician

Toddlers: 

1–3 y

Crying, tantrumsIrritability, 

sadness

Increased attention, holding, 

hugs

Preschoolers: 3–6 yPotty accidents, 

clinginess

Irritability, 

sadness

Increased attention, holding, 

hugs

School-age 

children: 

6–12 y

Whining, 

body aches

Irritability, 

sadness

Spending time, 

maintaining 

routines

Teenagers: 

12–18 y

Isolating, 

acting out, 

using drugs

Anger, 

apathy

Patience, 

limit-setting, 

counseling

about extent of the deployment, associated mission 

challenges, time commitment, the family’s capacity to 

manage the separation, and the ever-present risk of injury or death.3(p273),8(p1285) The stages of military deployment are listed in Table 30-1 and discussed below. The 

model developed by Pincus, revised to accommodate 

current deployment cycles during OIF, OEF, and ONE, 

is the source for the following section.9

Predeployment

The predeployment phase starts with the alert order 

for deployment and ends when the service members 

leave the home station. Its time frame can vary from 

several weeks to more than a year. The predeployment 

period often results in both denial and anticipation of 

separation. For many, the predominant feeling is loss 

of control.10(p632) As the departure date approaches, 

spouses often ask if the service members really must 

go. Increased field training, preparation, and long 

hours away from home mark the beginning of the 

pending extended separation.

As service members think and talk about the upcoming mission and their unit relationships, bonding 

with fellow unit members is essential to unit cohesion 

and safety during the mission, but it can create an 

increasing sense of emotional and physical distance 

for military spouses and children.9,11,12 Because of 

this psychological distancing, spouses often feel as 
490

Combat and Operational Behavioral Health

if their loved ones have already deployed. However, 

the change in focus from family to unit is a necessary 

part of the deployment process for active duty service 

members as they prepare for, and embrace, the mission. It can be especially demanding for the activated 

National Guard or Reserve service members who are 

transitioning from civilian to military life. By extension, 

spouses of National Guard and Reserve service members can have significant adjustment challenges during 

this transition. These complex issues can increase the 

individual service member’s negative feelings within 

the context of deployment.13(p633)

With deployment pending, families review their 

personal and family affairs to reorder their lives during 

the service member’s absence. Lists are generated to 

categorize a variety of expected needs: home repairs, 

home security, car maintenance, finances, insurance, 

tax preparation, childcare plans, and wills. Anxiety 

about financial and bill-paying responsibilities is often 

significant.14(p85) Couples may want increased intimacy 

and arrange for memorable holidays or anniversaries. 

Desire for sexual intimacy may be ambivalent, vacillating between wanting and not wanting to be close 

before the impending separation. Fears about marital 

fidelity may be raised or may go unspoken. Other 

frequently voiced concerns include anxiety about 

children’s ability to handle the separation, fears of 

functioning without the partner, and the survivability 

of the marriage. Completing the multitude of tasks 

and fulfilling high expectations before deployment can 

place tremendous strain on couples and families. 

It is not uncommon for military couples to argue 

before deployment.3,9 For well-established couples and 

those familiar with the deployment cycle, arguments 

may be accepted as part of the rhythm of marital life 

and adjustment to deployment. For less experienced 

couples, however, especially those facing an extended 

separation for the first time, such arguments can lead 

to fears that the relationship could be over. 

In 1980, Valentine cited the work of Evelyn Duvall, 

who identified “nine ever-changing family developmental tasks that span the life cycle.”15(p350) These tasks 

serve to establish and maintain (1) an independent 

home, (2) satisfactory ways of obtaining and spending 

money, (3) mutually acceptable patterns in the division 

of labor, (4) continuity of mutually satisfying sexual 

relationships, (5) an open system of emotional and 

intellectual communication, (6) workable relationships 

with relatives, (7) ways of interacting with associates 

and the community, (8) competency in bearing and 

rearing children, and (9) a workable philosophy of 

life.15(p350)

Unresolved family challenges have potentially 

devastating consequences. To a military commander, 

a worried, preoccupied service member is easily distracted and unable to focus on essential tasks during 

critical times. From a psychological perspective, it 

is easier to be angry than to confront the pain and 

loss of saying goodbye.2,16 In the worst-case scenario, 

unresolved emotional preoccupation can lead to serious accidents or the development of a combat stress 

disorder, which in turn can contribute to mission ineffectiveness.17–19 At home, significant spousal distress 

interferes with completing basic routines, concentrating at work, and attending to the children. This can 

exacerbate children’s fears that the parents are unable 

to adequately care for them or that the deployed parent 

will not return. Adverse child reactions include regressive behaviors such as inconsolable crying, apathy, or 

tantrums. A downward emotional spiral can result in 

which both service member and spouse become even 

more upset at the prospect of separating.

Kiser et al20(p90) outline seven characteristics of family 

resiliency: (1) a strong commitment to the family that 

involves a close bond and stable relationship with at 

least one person, (2) family organization with shared 

parental leadership and clear role boundaries, (3) belief 

in the family and its ability to succeed, (4) implementation of strategies to manage the demands created by 

stressors, (5) willingness to work to resolve issues, (6) 

maintenance of social connections, and (7) a coherent 

and positive understanding of stressors consistent with 

the family’s shared world view.20(p90) When military 

couples are able to explore and discuss their mutual 

expectations as they prepare for the deployment, they 

are more likely to successfully adjust throughout the 

phases of the deployment experience. Healthy couples 

will expect that nondeploying spouses will exercise 

their freedom to make independent decisions; maintain contact with same- and opposite-sex friends and 

neighbors (for assistance and socialization); budget 

effectively; care for children competently; and stay in 

touch through letters, care packages, e-mail messaging, 

and telephone calls. Failure to communicate these and 

other expectations is frequently a source of misperception, distortion, and hurt feelings during and after the 

deployment period. 

Deployment Phase

The deployment phase is the period from the service 

member’s departure from home through the first 

month of separation. Mixed emotions arise during 

this stage. Spouses may report feeling disoriented or 

overwhelmed, or they may feel relieved that they no 

longer have to appear brave and strong. There may be 

residual anger about tasks left undone by the deployed 

spouse. The departure creates a gap that can lead to 
491

The Impact of Deployment on Military Families and Children

feelings of numbness, sadness, loneliness, or abandonment. It is common for family members to have difficulty sleeping or coping with everyday challenges. 

Worries about home security and personal safety may 

come up again. Other concerns may involve pay problems, sick children, or car repairs. For many, the early 

part of the deployment stage can be an unpleasant, 

disorganizing experience. 

Although it is often assumed that only wives have 

such difficulties or concerns, these issues apply to 

spouses of either gender. Husbands may feel overwhelmed in taking responsibility for childcare, school 

attendance and homework, meals and shopping, 

medical and dental care, extracurricular activities, peer 

groups, friends, and social activities for their children. 

When new caregivers are brought in to assist families 

in the absence of the deployed parent, feelings of 

uncertainty can develop in children as they attempt 

to integrate another deployment-related change into 

their lives.

Sustainment Stage

The sustainment stage lasts from the end of the first 

month of the deployment to the month prior to return 

home. Sustainment is a time of establishing new sources 

of support and new routines. At home, many Army 

families rely on the local family readiness group (FRG), 

a garrison-based function that serves as a close network 

of community spouses and families. The FRG ideally 

meets on a regular basis to provide help with problems and disseminate information. The Army’s sister 

services have groups that perform similar functions. In 

addition, many military spouses are comfortable receiving support from their families, friends, churches, or 

other cultural, community, ethnic, or religious institutions as their primary means of emotional support. As 

challenges occur, most spouses find that they are able 

to cope with crises and make important decisions on 

their own. They report feeling more confident and in 

control. During the sustainment stage, most military 

spouses report that they can do what is needed to keep 

their families functioning successfully. 

Frequency, method, and content of communication 

between deployed service members and families are 

important factors at every stage of deployment, but 

especially during sustainment. The reality that phone 

contact is unscheduled and initiated by the service 

member can be frustrating. Spouses can feel tied to the 

house, not wanting to miss a call. Service members may 

feel forgotten if they call and no one is home, especially 

if they waited a long time to get to a phone. When expectations regarding the frequency of calls are unmet, 

resentment and anger may result. The Defense Satellite 

Network (DSN) offers time-limited calls home at no 

cost, depending upon location. Commercial phone 

lines are an option for some service members, but large 

phone bills can result, adding to family stress. More 

recently, some families are able to remain connected 

through video-teleconference capabilities via the Internet. For most military spouses, reconnecting with 

their loved ones is a stabilizing experience. For those 

who have difficult interactions during phone calls, the 

contact can exacerbate stress in the deployment stage 

and may result in the need for counseling.9

With e-mail now widely available, spouses and 

service members report feeling more in control; both 

are able to initiate communication, and they are not 

limited by the constraints of scheduling phone calls. 

Another advantage of e-mail is the ability to be more 

thoughtful about what is said and to monitor intense 

emotions that may be unnecessarily disturbing. However, e-mail security and restrictions can constrain 

some communication.

One disadvantage of the improved access to communication (phone calls or e-mail) is the immediacy 

of, and proximity to, unsettling news from either the 

family or the service member. It is virtually impossible 

to disguise negative feelings of hurt, anger, frustration and loss, especially on the phone. Inaccurate and 

disappointing news may travel quickly by personal 

cellular phones.

Unsubstantiated rumors can circulate unchecked 

within the FRG.9

 Rumors involving allegations of infidelity can be particularly damaging. Other troubling 

rumors may involve innuendo that a particular spouse 

or service member is handling the deployment poorly, 

combat accidents or injuries, unexpected changes in 

the date of return, or disciplinary actions. Rumors can 

be hurtful to service members, spouses, and the FRG. 

At its worst, unit cohesion and even mission success 

can suffer. Limiting the negative effect of rumors is a 

constant challenge for unit leaders and chaplains. The 

rapidity of crosscommunication of potentially inaccurate news can undermine the ability of the service 

member, unit, or family to focus and perform safely.

Late Deployment Stage 

The late deployment stage is defined as the month 

before the service member returns home. Deployments 

occurring during the OIF surge have been marked by 

unexpected and late announced extensions of combat 

tours. Deployment extensions typically lead to frustration and anxiety for all involved and can introduce 

unexpected strain at a time when everyone is looking 

forward to the service member’s return. The late deployment stage is generally one of great anticipation. 
492

Combat and Operational Behavioral Health

As in the deployment stage, there can be a rush of conflicting emotions: excitement that the soldier is coming 

home, apprehension, concern that spouses may not 

agree with how things have been managed, worry 

about whether independence will be lost or how roles 

will shift, and concern about whether family members 

will get along. With the separation almost over, there 

can be renewed difficulty making decisions. A spouse 

may wonder whether decisions should be deferred 

until the service member is home to make them. Many 

spouses also experience a burst of energy during this 

stage,9,16 a rush to complete tasks around the home. 

During late deployment, expectations of service members, spouses, and children all are high.

Postdeployment 

Postdeployment begins with the service member’s 

return from theater and arrival home, sometimes first 

to the clearing station or demobilization station. Like 

predeployment, the time frame can be variable. The 

actual homecoming is often ceremonial and can be a 

joyous occasion. Children rush to the returning parent 

and the reunited couple embrace. The unit commander 

calls the unit to attention, praises unit members for 

their service, and then dismisses them. Weapons and 

equipment are turned in, and further demobilization 

tasks (including health evaluations, mental health 

surveys, and family health surveys) are completed. 

Finally, the family goes home. Homecoming can also 

be a frustrating and upsetting experience. The date 

of return may change, or units may travel home in 

separate groups over several days. Spouses may be 

required to attend to other unexpected family obligations, such as sick children.

A “honeymoon” period usually follows the homecoming, during which families reunite; however, they 

may soon find themselves feeling emotionally distant. 

Some spouses describe awkwardness in addition to 

excitement, especially reestablishing intimacy after 

so many months of separation. Emotional reconnection may require time before sexual intimacy feels 

comfortable. Eventually, returning service members 

reassert their role as spouse or parent within the family.16 This is an essential task that can flow naturally 

or lead to tension within the family. Service members 

may feel pressure to make up for lost time and missed 

milestones. They may want to quickly reestablish the 

authority they had before. However, some things will 

have changed in their absence: spouses typically become more autonomous during deployments, children 

have grown, and individual personal priorities in life 

may be different. It is not realistic to expect everything 

to be the same as before the deployment. 

During the postdeployment period, spouses may 

report a lost sense of independence or resentment at 

having been left on their own. Spouses may consider 

themselves to be the true heroes, who managed things 

while service members were away. At least one study21

suggests that stay-at-home parents are more likely to 

report distress than the deployed service members. 

Like their military spouses, nondeployed spouses 

also have to adapt to changes that result from the 

homecoming, and may find they are more irritable 

with their mates around. They may desire to retain a 

sense of their own space. Basic household chores and 

routines need to be renegotiated. Roles played by each 

spouse in the marriage must be reestablished, perhaps 

in a new form. 

Reunions with children can be both joyful and 

challenging. Youngsters’ feelings tend to depend on 

their age and their understanding of the reason for the 

service member’s absence. Babies less than 1 year old 

may not know the returned parent and cry when held. 

Toddlers (1–3 years) may be slow to warm up. Preschoolers (3–6 years) may feel guilty or scared about 

future separations. School-age children (6–12 years) 

may want a lot of attention. Teenagers (13–18 years) 

may be moody and may not appear to care. Children 

are often loyal to the parent who remained behind 

and may not respond initially to discipline from the 

returning service member. Children may also fear 

the military parent’s return if a threat of discipline or 

consequences has been put forward. Some children 

may display ongoing anxiety triggered by the real possibility of future deployments. The returned service 

member may not agree with privileges granted to children by the nondeployed parent. Generally, reunited 

parents should not make immediate changes, instead 

taking time to renegotiate family rules and norms. 

Otherwise, the service member risks invalidating the 

efforts of the nondeployed parent and alienating the 

children. Returning service members may feel hurt in 

response to a perceived ambivalent reception. Clearly, 

making changes slowly and allowing children to set 

the pace for reintegration can lead to a successful 

reunion. 

Postdeployment is probably the most critical stage 

for service member, spouse, and children. Successful 

reintegration is aided by fostering patient communication, setting reasonable expectations, and taking 

time for family members to reacquaint.9,16 Counseling 

may be required if the soldier is injured, returns with 

unrelenting psychiatric symptoms, or engages in 

health-risk behaviors such as excessive alcohol use or 

physical displays of anger. Nevertheless, the separation experienced during the deployment offers service 

member and spouse a chance to evaluate changes 
493

The Impact of Deployment on Military Families and Children

within themselves and what direction they want their 

marriage to take. Postdeployment is both a difficult 

and joyful stage, and many military couples have reported that their relationship is stronger as a result.

Effects of Deployment on SPOUSES

Soon after the August 1990 announcement that the 

United States would send troops to the Persian Gulf, 

Rosen et al22(p47) were tasked to study the impact of 

deployment on service member and family well-being. 

They studied Army spouses to determine which group 

had the most difficulty coping during ODS/S. They 

identified three vulnerable groups: (1) enlisted spouses 

under 30 years of age, many of whom were Spanish 

speaking and many married to noncommissioned 

officers; (2) very young spouses of junior enlisted, especially those living off post; and (3) older, employed 

spouses who faced their own unique stresses.

In May 2003, Haas et al surveyed23 pregnant military and civilian women in the antenatal clinic at the 

Naval Hospital Camp Lejeune to measure stress levels. Almost predictably, women whose partners were 

deployed and who already had more than one child 

at home reported higher levels of stress (up to eight 

times greater than those with no children at home) 

than their peers who were married to nondeployed 

military members.23(p48)Another study conducted in 

a southeastern Virginia Navy community looked at 

families whose service members deployed to the Mediterranean between 1989 and 1991.24(p103) The authors 

found that deployment associated with combat had 

the strongest effect on spouses, predisposing them to 

depression. 

Not all military families are traditional in constellation; some are single-parent families and some are 

blended families. Although in past wars most deploying service members were men, this is no longer the 

case. In 1993, Birgenheier25 (quoting data from Magnusson and Payne) noted that women comprised more 

than 10% of the military, and that 14% of them, along 

with 4% of military service men, were single parents. 

With the onset of Operation Desert Storm on January 

15, 1991, mothers were assigned to combat settings for 

the first time.25(p471) 

Children’s Developmental Responses During Deployment

Forty percent of service members have children, 

approximately one third of whom are less than 5 years 

of age. Children of varying ages respond differently to 

deployment stress. Their strengths and vulnerabilities 

are determined by stages of psychosocial development. Parents or other caring adults must avoid burdening children of any age with matters that are more 

appropriate to adults. 

Some children may have greater difficulty adapting 

to the stress of a deployed parent. Signs or symptoms 

indicating an inability to return to normal routines 

or the presence of more serious problems require a 

visit to the family doctor or mental health counselor. 

Despite obstacles, the vast majority of spouses and 

children successfully negotiate the sustainment stage 

and look forward to their deployed family member 

coming home. Table 30-1 provides examples of negative behavioral and emotional changes in children of 

different ages that require further attention.

Infants

Infants (< 1 year; the Eriksonian psychosocial developmental stage of “trust versus mistrust”26) thrive 

when held and actively nurtured. The infant is at 

risk when a primary caregiver becomes significantly 

depressed or otherwise emotionally unavailable. 

Infantile depression may present with symptoms of 

apathy, irritability, eating refusal, or weight loss. Early 

intervention becomes critical to prevent undue harm 

or neglect. In particular, pediatricians should monitor 

growth. Personnel in community services, social work, 

pediatrics, and psychiatry must assist with parental 

support and treatment, parental skill development, 

and coordination of appropriate family services. 

Toddlers

Toddlers (1–3 years; the Eriksonian psychosocial 

developmental stage of “autonomy versus shame,”26) 

generally take their emotional and behavioral cues 

from their primary caregivers. If the home-based 

parent is coping well, the toddler tends to do well. 

The opposite is also true. If the primary caregiver is 

not coping well, then toddlers may become sullen or 

tearful, throw tantrums, or develop sleep or eating 

disturbances. Toddlers respond to increased attention such as playing together, hugs, or longer bedtime 

rituals. Given the challenges of caring for young, active children, home-based parents should balance the 

demands for caring for children alone with their own 

needs for time. Parents may also benefit from sharing 

their day-to-day experiences with other parents facing 

similar challenges.
494

Combat and Operational Behavioral Health

Preschoolers

Preschoolers (3–5/6 years; the Eriksonian psychosocial developmental stage of “initiative versus 

guilt,”26) may regress in acquired skills as a result 

of deployment stress. This regression may manifest 

itself as loss of toilet training, change in language 

use, thumb sucking, refusal to sleep alone, or increased neediness. Young children may become 

more irritable, depressed, or aggressive. They are 

prone to somatic complaints and can develop more 

pervasive fears of losing parents or other important 

adults. Caregivers need to reassure preschoolers 

with extra attention and physical closeness (hugs, 

holding hands). Adults should avoid changing family routines; they should support developmental 

accomplishments, such as encouraging youngsters 

to continue to sleep in their own bed. Answers to 

questions about the deployment should be brief, 

matter-of-fact, and to the point. Consistency of routines and expectations, although important for all 

age groups, provides greater comfort and security 

for younger children in particular. 

School-Age Children

School-age children (6–12 years; the Eriksonian 

psychosocial developmental stage of “industry versus inferiority,”26) may whine and complain, develop 

somatic complaints, become aggressive, or otherwise 

behaviorally demonstrate their feelings. They may focus on the military parent missing a key event such as 

a birthday, school play, or important game. Depressive 

symptoms may present as sleep disturbance, loss of interest in school, changes in eating habits, or decreased 

desire to play with friends. School-age children benefit 

from talking about their feelings and need more physical attention than usual. Although some reduction in 

school performance may occur, parental expectations 

and routines should largely remain the same.

Rosen et al27 studied children’s responses during 

ODS/S deployments, finding that sadness was fairly 

widespread in both boys and girls aged 3 to 12 years 

old. Children’s symptoms sometimes varied with birth 

order. Discipline problems and immature behaviors 

were more prominent in eldest children (mean age 7.2 

+/− 5.4 years). Academic problems and refusing to 

talk were noted more in second children. Both groups 

evidenced eating and sleeping problems as well as 

increased need for adult attention.27(p466) Kelley24 reported that the children of ODS/S combat-deployed 

service members demonstrated more internalizing 

and externalizing behaviors that took longer to resolve 

after the father’s return. The frequently quoted study 

by Jensen et al28 focused on children’s responses to parental separation during ODS/S. In this study, ODS/S 

combat deployments were related to elevated, but 

not pathological, depressive and anxiety symptoms 

for both the nondeployed spouse and the children, 

as measured by parental reports. Boys and younger 

children appeared especially vulnerable to deployment effects.28

Adolescents

Adolescents (13–18 years; the Eriksonian psychosocial developmental stage of “identity versus role confusion,”26) may be irritable or rebellious. Teens might 

argue or participate in other attention-getting behavior. 

Huebner and Mancini29 noted that adolescents face a 

number of normal developmental stressors, including 

puberty. These normal stressors combined with the 

multiple challenges of deployment can push teenagers’ coping capacities beyond their limits. With their 

developing cognitive capacity for abstract thought 

and more complex emotional lives, adolescents may 

experience ambivalent feelings, such as anger mixed 

with pride in the deployed parent. They can also experience a sense of loss and uncertainty about whether 

they will see the parent again. 

Changes in responsibilities and roles during deployment may be challenging, but also provide older 

children and teens with an opportunity for greater 

independence and growth. The return of the deployed 

parent can be more difficult due to the potential loss 

of these newly earned responsibilities. In Huebner’s 

study, teens were more aware of having become closer 

to their nondeployed parents (mothers) and struggled 

to return to their previous roles and relationships at 

the end of the deployment. These adolescents also 

reported being aware of more intense family relations 

and of their own fluctuating emotions.29(pp3,9,10) 

During parental deployments, adolescents may 

show a lack of interest in school, peers, and school 

activities. They are at greater risk for promiscuity, 

alcohol use, and drug use. Although teens may deny 

problems and worries, it is extremely important for 

caregivers to stay engaged and be available to talk 

about the teens’ concerns. Sports and peer or family social activities should be encouraged to give 

normal structure to teens’ lives. Academic tasks can 

add further order to a teenager’s life. Likewise, additional responsibility in the family, commensurate 

with their emotional maturity, helps teens feel important and needed. Monetary incentives can also 

contribute positively to the maintenance of grades 

and chores. Adolescents should not, however, be 

placed in roles of coparenting or serve as confidantes 
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The Impact of Deployment on Military Families and Children

to the nondeployed spouse. Even the most capable 

adolescents need to know that competent adults 

remain in charge and will look after and care for the 

adolescents’ needs.

Intergenerational Transmission of the Effects of War and Combat Trauma

Newer research has identified elevated rates of 

PTSD and depression in service members returning 

from combat deployment in Iraq, with approximately 

20% of these personnel evidencing symptoms indicative of a mental disorder.30 It is essential to consider 

the impact of these postcombat conditions on families, 

particularly children. Intergenerational trauma transmission, sometimes referred to as secondary traumatization, is a phenomenon whereby children are affected 

by their parent’s posttraumatic sequelae.31 A body of 

literature in this field has emerged since the mid-1960s, 

when the subject was first considered in work with 

families of Holocaust survivors.32 Interest in the subject 

continued with the 1983 National Vietnam Veterans 

Readjustment Study (NVVRS), which was established 

in response to a congressional mandate for an investigation of PTSD and other postwar psychological problems among Vietnam veterans.33 Numerous studies 

were conducted with families of Vietnam veterans that 

examined the psychological, behavioral, and adaptive 

styles of children of veterans. Additional work in the 

field of intergenerational trauma studies has focused 

on the impact of multiple traumas (genocide, political 

violence, repressive regimes, domestic violence, crime, 

and life-threatening diseases)34 on survivor’s children. 

In such cases, the children did not experience the actual 

traumatic events, but were affected by their parents’ 

traumatic experiences.

The multigenerational repercussions of trauma 

are well documented in anecdotal data. Children of 

Holocaust survivors report feeling that they have 

absorbed their parents’ Holocaust experiences as if 

“through osmosis.”35 Many children of Holocaust 

survivors describe an unspoken presence of the Holocaust in the home that served as an organizing force 

underlying family communications and relationships. 

Many reported that their parents never spoke about 

the traumas they endured, giving rise to the term 

“conspiracy of silence.”35 This “conspiracy” refers to 

an avoidance of discussion within the family as well 

as within society at large of the horrors experienced 

by Holocaust survivors. This silence is regarded as a 

powerful means of transmission of the impact of the 

parental trauma.

Initial clinical observations in the 1960s noted 

significant anxiety, depression, and maladaptive behaviors in children of Holocaust survivors.36 The early 

literature was generally presumptive of significant 

psychopathology, given the severity and duration 

of the traumatic experiences of the parents who had 

little opportunity to integrate their massive losses and 

traumatic experiences. Over time, these results were 

questioned because of methodological weaknesses and 

lack of reliable data.37 Questions naturally arose about 

how to assess the meaning and impact of any parental 

trauma on a child. New interest developed in considering the strengths that parents confer to their children 

as a result of their histories of traumatization.32

Similarly, studies of children of Vietnam veterans 

present a range of findings and conclusions. Some 

reports indicate that children of veterans had difficulties in academic performance, peer relations, and 

affective coping, with general deficits in psychosocial 

functioning.38 The NVVRS determined that on over 

100 life-adjustment indices, the majority of Vietnam 

veterans successfully adjusted to postwar life with few 

symptoms of psychological disorders.33 Other studies 

raised concerns over the adverse impact on children related to their fathers’ combat-related PTSD, emotional 

numbing,39 or participation in acts of abusive violence 

during combat.40 Studies appearing in the literature by 

the mid-1980s suggested that children of fathers with 

PTSD were at increased risk for learning disabilities, 

aggression, depression, and hyperactivity.41

A significant factor in the emergence of intergenerational trauma transmission appears to be related 

to whether the veteran parent had, or did not have, 

symptoms of PTSD. NVVRS data indicate a relationship between PTSD and family disruption, as well as 

marital instability and child behavioral problems.40

Parental feelings of detachment or inability to feel 

and express emotions were noted to carry over into 

the parenting relationship, possibly leading to behavioral problems in children. Significantly, affective 

avoidance and emotional numbing are most highly 

correlated with behavioral difficulties in children of 

veterans.42 The literature also notes that veterans who 

have participated in abusive violence or atrocities see 

themselves as social outcasts and have difficulty trusting others. These views can contribute to increased 

family violence and difficulty with the formation of 

nurturing parenting bonds.40 

Intergenerational trauma transmission appears to 

occur most significantly when second-generation children experience trauma themselves. Vietnam veterans 

who were sons of World War II veterans and who were 

diagnosed with PTSD had more severe and persistent symptoms than veterans whose parents had not 
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Combat and Operational Behavioral Health

been exposed to combat. Problems for these Vietnam 

veterans emerged at the time of homecoming, with 

clashes in ideology between fathers who fought the 

“good war” and sons who fought an unpopular war. 

The lack of support for returning Vietnam veterans 

may have impeded the resolution of PTSD symptoms 

and facilitated the intergenerational transmission of 

combat-related trauma for those with veteran fathers.43

Similarly, Israeli veterans of the 1982 Lebanon War 

who were sons of Holocaust survivors were also noted 

to have especially severe and persistent symptoms 

of PTSD compared with control groups, suggesting 

that intergenerational trauma transmission is more 

pronounced when the offspring experience personal 

traumas.44

A veteran’s PTSD can affect children in a number of 

ways. The parent’s reexperiencing of traumatic events 

can be sudden, intense, and vivid. These intrusions are 

very frightening to children, who do not understand 

what is happening. Children may worry about the parent’s well-being, or the parent’s ability to provide care 

for them. Parents with emotional numbing and who 

are “shut down” can seem remote and uninvolved to 

their children. The parent may seem uncaring, and the 

child may feel unloved. Symptoms of anxiety, hyperarousal, irritability, and low frustration tolerance can 

influence a child’s sense of safety and can cause the 

child to question the parent’s love.33

Children of combat veterans with PTSD have been 

observed to fall into three general response types: (1) 

the disengaged child, (2) the overidentified child, and 

(3) the rescuer child. While the disengaged child may 

become emotionally detached from family life, the 

overidentified child tries to become closer to the parent 

at the expense of age-appropriate activities and peer 

relationships. This child may experience flashbacks 

and nightmares that are similar to the veteran parent. 

The rescuer child, similar to the child of an alcoholic, 

tends to feel responsible for the parent’s problems and 

guilty when things do not go well. This child takes on 

parental roles and responsibilities.38

Trauma involves a disruption of emotions, beliefs, 

and cognitions. The parent may return from combat 

with altered thoughts, feelings, and behaviors in the 

aftermath of a single traumatic event, or as a result 

of prolonged exposure to the intensity of the combat 

experience. There may be change in parents’ fundamental sense of themselves as people, and in the way 

they view themselves within the context of society as 

well as within their interpersonal relationships. Issues 

of safety and trust can be deeply affected by trauma, 

reshaping an individual’s beliefs about relationships 

and about the world at large.37 Intergenerational 

transmission of the impact of parental trauma occurs 

when the parent’s disrupted beliefs and assumptions 

are communicated to a child who has not experienced 

the trauma but who comes to internalize a set of feelings or beliefs that parallel those of the traumatized 

parent. 

Mechanisms of intergenerational transmission 

of trauma described by Ancharoff and colleagues37

include silence, overdisclosure, identification, and 

reenactment. In an environment of silence, the child 

experiences the impact of the parent’s trauma affectively but in the absence of explanation or reassurance. The family sometimes colludes in avoiding 

difficult subjects or any trigger to the traumatized 

parent’s symptoms. The child can have frightening 

fantasies about the parent’s unspoken experience 

and feel anxious about provoking the parent’s symptoms. Overdisclosure occurs when the parent reveals 

frightening or horrific details that the child cannot 

tolerate and that may cause the child to develop PTSD 

symptoms. Identification may occur when a child 

tries to connect emotionally with a parent who is 

otherwise withdrawn and unavailable. Reenactment 

occurs when family members are involved in reliving some aspect of a traumatic memory as a result of 

the parent’s difficulty with separating the past from 

the present.37 

Not all children develop emotional problems in 

the aftermath of the parent’s combat experience or 

PTSD symptoms. However, when a child is expressing 

emotional problems at home or in school, a comprehensive assessment of the child’s social and academic 

status is indicated. This assessment should include an 

evaluation of overall family functioning and patterns 

of communication.

Because trauma involves betrayal of trust, all 

trauma-related work must occur within a safe and 

trusting therapeutic relationship. Individual treatment 

may be needed prior to participation in family therapy. 

The goal of intervention is to help the family recognize 

its patterns of communication, to develop beliefs and 

behaviors that distinguish the past from the present, 

and to have an expanded range of responses.37 The 

combat veteran or any survivor of trauma must find 

a way to integrate past experiences with the present 

reality in a way that feels meaningful and hopeful. 

If silence attests to an inability to integrate trauma,34

then the therapeutic dialogue must skillfully address 

this silence because it disrupts a sense of continuity 

of self and experience. The therapist does not seek to 

elicit detailed descriptions of the parent’s traumatic 

experiences. Rather, assisting the family to develop 

new interactive patterns through a more informed 

awareness of family communication patterns is an 

appropriate goal in addressing the intergenerational 
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The Impact of Deployment on Military Families and Children

transmission of the effects of combat trauma.

The emerging body of anecdotal and empirical 

literature suggests that interpersonal relationships 

are affected by the profoundly disruptive nature of 

trauma. The issues are highly complex; over the past 

40 years researchers have sought to identify, qualify, 

and measure the impact of parental trauma on children. If trauma occurs, how does it occur and how 

does it affect future generations and manifest in these 

successive generations? However, over the years since 

ODS/S, service members and their families have had 

to adapt to a major shift in US foreign policy and in 

the role of the US military in extended multinational 

deployments. The Bosnian experience provided new 

insight into the different skills needed to minimize 

familial trauma. Research on ODS/S veterans has 

further added to knowledge of this subject. However, 

the multiple and lengthy combat deployments of 

OEF and OIF have posed new challenges for military 

service members, their families, and children. It is 

unclear to what degree the traumatic experiences of 

service members involved in OEF and OIF will impact 

their children. Family well-being is not only essential 

to mission success, but also to the future health of the 

military in its efforts to retain skilled military service 

members.45,46

SUMMARY

The military, Department of Veterans Affairs, and 

TRICARE civilian healthcare professionals must 

be prepared to support service members and their 

families through the five stages of deployment, and 

the sequelae that might result from service member 

combat exposure. Given the established 20% rate of 

mental illness in returning OIF veterans, the multigenerational effects of combat-related stress and trauma 

must be considered as a possible health effect of the 

current conflicts. Public and professional education 

efforts on these topics are essential for families to cope 

effectively with the deployment experience and seek 

help if problems develop. Additional research addressing the impact of deployment on service members and 

their families will better ensure that US military forces 

are prepared for the challenges of the next conflict.

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21. Zeff KN, Lewis SJ, Hirsch KA. Military family adaptation to United Nations Operations in Somalia. Mil Med. 

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ATTACHMENT: RESOURCES FOR MILITARY FAMILIES

An important endeavor for military members and their families is navigating through the many resources 

available to help them through the deployment cycle. Although not an exhaustive list, this attachment includes 

a number of these resources and a synopsis of their purposes.

Organizations Supporting the Service Member and Military Family

Military OneSource 

Military OneSource (available at: http://www.militaryonesource.com) is a service provided by the Department 

of Defense at no cost to active duty, National Guard, and reserve (regardless of activation status) soldiers and 

their families. The agency promotes multiple services such as help with childcare, personal finances, emotional 

support during deployments, relocation information, and resources needed for special circumstances. These 

services can be accessed by telephone, online, and face to face through private counseling with master’s level 

consultants in the local community.

Information on Helping Military Children 

The Department of Defense, in partnership with LIFELines organizations, provide a Web site as the department’s official source of education information (available at: www.militarystudent.org). Its purpose is to better 

enable the children of military personnel, their parents, special needs families, military leaders, and educators 

deal with the various issues that face the military child by providing each group with access to information, tools, 

and resources from a central location. Ultimately, the aim is to enhance the educational and social well-being of 

all military children by increasing the understanding and awareness of how to meet their unique needs.

Educational Resources Available to Aid Bereaved Children and Their Families

The New York University Child Study Center created a Web site (available at: www.aboutourkids.org) dedicated to advancing the field of child mental health through evidence-based practice, science, and education. Using 

the search engine on the site to look up information on bereavement, users can gain access to a list of books on 

bereavement, war, terrorism, and tolerance targeted at children of all ages, parents, and professionals.

National Child Traumatic Stress Network Guideline on Managing Childhood Traumatic Grief 

 The National Child Traumatic Stress Network, a consortium of treatment and research centers across the United 

States, provides an online guideline (available at: http://www.nctsnet.org/nccts/nav.do?pid=hom_main). The 

network comprises 70 member centers—45 current grantees and 25 previous grantees —funded by the Center for 

Mental Health Services, Substance Abuse and Mental Health Services Administration, US Department of Health 

and Human Services, through a congressional initiative—the Donald J Cohen National Child Traumatic Stress 

Initiative. This initiative recognizes the profound, destructive, and widespread impact of trauma on American 

children’s lives and seeks to improve the quality, effectiveness, provision, and availability of therapeutic services 

delivered to all children and adolescents experiencing traumatic events.

Department of Defense Military Assistance Program

The Military Assistance Program (available at: http://dod.mil/mapsite/) aims to provide information and 

interactive resources for assisting military families with relocation, money management, and job search at a 

new location.

Operation Special Delivery

 Operation Special Delivery (available at: http://www.operationspecialdelivery.com) provides trained volunteer doulas for pregnant women whose husbands or partners have been severely injured or who have lost 
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The Impact of Deployment on Military Families and Children

their lives due to the current war on terror, or who will be deployed at the time they are due to give birth. The 

doulas are informational, emotional, and physical coaches, not medical providers.

SGT Mom’s 

SGT Mom’s (available at: http://www.family-networks.org/military. cfm) is an interactive Web site created in 

1996 and run by a military spouse who handles all e-mails, updates, and additions. It is not an official Department 

of Defense site and is not related to any official military organization. The Web site contains a communication 

forum, links to other sites, the latest news about military families, ways to support troops, and a question-andanswer section. SGT Mom’s is “military life explained by a military wife.”

The National Long Distance Relationship Building Institute (Dads at a Distance)

As stated on the homepage, the Dads at a Distance Web site (available at: http://www.daads.com) was created “to help fathers who are business travelers, military men, non-custodial fathers, airline pilots, travel guides, 

traveling salesmen, railroad workers, truckers, professional athletes, musicians, entertainers, actors, corporate 

executives, or any other fathers who have to be away from their children to maintain and strengthen their relationships with their children while they are away.” The Web site provides tips for long-distance fathers, links to 

related Web sites, information on relevant products and books, and stories of long-distance fathering.

The Tragedy Assistance Program for Survivors 

The Tragedy Assistance Program for Survivors, or TAPS (Available at: http://www.TAPS.org) was founded 

after the deaths of eight soldiers aboard an Army National Guard aircraft in November 1992. TAPS provides a 

support network for the surviving families of those who have died in service to America. To accomplish their 

mission, TAPS has experienced caseworkers who act as liaisons, assisting the family members in finding solutions to problems. TAPS’ small professional staff and a large national volunteer network work hand-in-hand 

with federal, state, and private agencies in finding solutions to problems of surviving military families.

The Building Strong and Ready Families Program 

This is a 2-day program that helps couples develop better communication skills, reinforced by a weekend retreat. Additional information is available at http://www.strongbonds.org/skins/strongbonds/display.aspx. 

The PICK (Premarital Interpersonal Choices and Knowledge) a Partner Program

This program helps single soldiers make wise decisions when they choose mates.

Additional Phone Numbers and Web Sites

Army Military Family Research Institute: http://www.mfri.purdue.edu/pages/news/soldier_family_well_being.html 

Army OneSource: 1-800-464-8107; http://www.armyonesource.com (User ID: army; Password: onesource)

Department of Veterans Affairs: http://www.va.gov

National Center for PTSD: http://www.ncptsd.org/ 

Deployment Health Clinical Center: 1-800-796-9699; http://www.pdhealth.mil

HOOAH4HEALTH—Deployment: http://www.hooah4health.com/deployment/default.htm

Institute of Medicine—Health of Veterans and Deployed Forces: http://veterans.iom.edu/ 

Operations Noble Eagle, Enduring Freedom, and Iraqi Freedom: http://www.odcsper.army.mil/default.

asp?pageeid+37

Reserve Affairs—Mobilization and Demobilization: http://www.defenselink.mil/ra/html/mobilization.html

Veterans Benefits Administration: 1-800-827-1000

Veterans Health Administration: 1-800-222-8387
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