Research Article
Abstract
Cross-culturally effective, low-threshold therapies for refugees that can be carried out quickly are urgently required. Worldwide, therapies are lacking, particularly for preschool refugee children, which support coping and prevent chronification of posttraumatic stress. This pilot study examined eye movement desensitization and reprocessing (EMDR)-based group treatment for preschool refugee children in German daycare centers. Ten refugee preschool children aged 4–6 years (n = 5 female) with posttraumatic stress disorder (PTSD) symptoms took part in an EMDR-based group treatment (with 2–4 children per group). PTSD symptoms were rated by parents and preschool teachers using items from the Child Behavior Checklist (CBCL 1½–5), pre- and posttreatment, and at 3-month follow-up. After treatment children tended to display less fear of animals or situations than before treatment. According to preschool teachers' perspective, the total number of PTSD symptoms dropped significantly at posttreatment (d = .93) and at follow-up (d = .81). Before the intervention, preschool teachers rated the children as being more defiant than their parents did (p = .020). After the intervention, the PTSD symptoms of boys were significantly higher than those of girls (p = .036) according to preschool teachers. The results indicate that timely psychotherapeutic interventions can be conducted with refugee children displaying PTSD symptoms in daycare centers. The efficacy of this intervention needs to be studied in a larger sample under controlled randomized conditions.
Figures
Tables
Md (Range) | n (%) | n.a. in n (%) | |
---|---|---|---|
Gender | |||
Male | – | 5 (50) | – |
Age (years) | 5.0 [4 – 6] | – | – |
Country of birth | |||
Afghanistan | – | 4 (40) | – |
Syria | – | 6 (60) | – |
Duration of stay at time t0 (days) | 451.5 [223 – 832] | – | 2 (20) |
Duration of flight (months) | 1.6 [0.5 – 4.0] | – | 2 (20) |
Age on arrival (years) | 3.5 [3 – 4] | – | 2 (20) |
Existing illness, disability or developmental disorders | – | 1 (10) | 2 (20) |
Note. Md = Median; median and range rounded to one decimal place; n.a. = not available. All percentages calculated based on overall sample.
t0 | t1 | t2 | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Parentsa (n = 10) | Preschool teachersa (n = 10) | * ** *** | Parentsa (n = 8) | Preschool teachersa (n = 9) | * ** *** | Parentsa (n = 6) | Preschool teachersa (n = 8) | * ** *** | |||||||
Items from CBCL 1 ½–5 [item number] | n | % | n | % | p | n | % | n | % | p | n | % | n | % | p |
Unable to concentrate / pay attention for long [5] | 6 | 60 | 7 | 70 | n.s. | 6 | 75 | 6 | 67 | n.s. | 4 | 67 | 7 | 86 | n.s. |
Clings to grown-ups / is too dependent [10] | 7 | 70 | 4 | 40 | n.s. | 3 | 38 | 2 | 22 | n.s. | 3 | 50 | 1 | 13 | n.s. |
Is defiant [15] | 3 | 30 | 9 | 90 | .02 | 2 | 25 | 5 | 56 | n.s. | 3 | 50 | 4 | 50 | n.s. |
Is afraid of certain animals / situations / places [32] | 9 | 90 | 4 | 40 | n.s. | 4 | 50 | 2 | 22 | n.s. | 2 | 33 | 1 | 13 | n.s. |
Nausea (without known physical causes) [45] | 1 | 10 | – | – | n.s. | – | – | – | – | n.c. | 1 | 17 | – | – | n.s. |
Is nervous / tense [47] | 5 | 50 | 6 | 60 | n.s. | 2 | 25 | 3 | 33 | n.s. | 3 | 50 | 2 | 25 | n.s. |
Has nightmares [48] | 3 | 30 | 2 | 20 | n.s. | 2 | 25 | – | – | n.s. | 2 | 33 | – | – | n.s. |
Stomachaches / stomach cramps (without physical cause) [78] | 3 | 30 | 1 | 10 | n.s. | 2 | 25 | – | – | n.s. | 1 | 17 | 1 | 13 | n.s. |
Is stubborn, sullen, or irritable [81] | 4 | 40 | 7 | 70 | n.s. | 5 | 63 | 4 | 44 | n.s. | 2 | 33 | 4 | 50 | n.s. |
Displays sudden changes in mood /feelings [82] | 6 | 60 | 6 | 60 | n.s. | 2 | 25 | 3 | 33 | n.s. | 4 | 67 | 4 | 50 | n.s. |
Is too afraid, is anxious [87] | 5 | 50 | 5 | 50 | n.s. | 5 | 63 | 3 | 33 | n.s. | 3 | 50 | 2 | 25 | n.s. |
Is unhappy / sad / depressed [90] | 2 | 20 | 4 | 40 | n.s. | 2 | 25 | 5 | 56 | n.s. | 1 | 17 | 4 | 50 | n.s. |
Vomiting (without known physical cause) [93] | – | – | – | – | n.c. | – | – | – | – | n.c. | 1 | 17 | – | – | n.s. |
Wakes up frequently at night [94] | 3 | 30 | 1 | 10 | n.s. | 2 | 25 | – | – | n.s. | 3 | 50 | – | – | n.s. |
Is withdrawn / does not make contact with others [98] | 4 | 40 | 6 | 60 | n.s. | 5 | 63 | 5 | 56 | n.s. | 1 | 17 | 1 | 13 | n.s. |
Sum score >8 | 4 | 40 | 6 | 60 | – | 2 | 25 | 2 | 22 | – | 2 | 33 | 2 | 25 | – |
Other [-] | 4 | 40 | 1 | 10 | – | – | – | 1 | 11 | – | – | – | 1 | 13 | – |
Note. CBCL = Child Behavior Checklist.
a Items were dichotomized for analysis: responses of (1) applies somewhat/sometimes and (2) applies exactly/often were counted as “symptom is present”; n.s. = not significant; n.c. = not able to be calculated; the χ2 test was used (or Fisher's exact test in cases with low cell frequencies).
t0 | t1 | t2 | Friedman Test | |||||||
As seen by … | Md [Range] | MR | Md [Range] | MR | Md [Range] | MR | n | χ2 | df | p |
n = 10 | n = 8 | n = 6 | ||||||||
Parents | 5.5 [2–16] | 2.75 | 6.5 [1–12] | 1.75 | 6.5 [2–10] | 1.50 | 6 | 5.727 | 2 | .057 |
n = 10 | n = 9 | n = 8 | ||||||||
Preschool teachers | 9.5 [2–17] | 2.75 | 7.0 [0–13] | 1.56 | 3.5 [0–17] | 1.69 | 8 | 7.032 | 2 | .030 |
Note. df = degrees of freedom; Md = Median; MR = mean rank.
As seen by … | t0 | t1 | t2 | Chi-Squared Test | ||
n = 10 | n = 8 | n = 6 | χ2 | df | p | |
Parents | 4 (40%) | 2 (25%) | 2 (33%) | .450 | 2 | .799 |
n = 10 | n = 9 | n = 8 | ||||
Preschool teachers | 6 (60%) | 2 (22%) | 2 (25%) | 3.605 | 2 | .165 |
Note. df = degrees of freedom; Md = Median; MR = mean rank.
Period | Abstract | Full | Total | |
---|---|---|---|---|
Apr 2024 | 23 | 23 | 27 | 73 |
Mar 2024 | 15 | 18 | 22 | 55 |
Feb 2024 | 21 | 20 | 20 | 61 |
Jan 2024 | 51 | 54 | 21 | 126 |
Dec 2023 | 23 | 19 | 23 | 65 |
Nov 2023 | 27 | 20 | 13 | 60 |
Oct 2023 | 17 | 31 | 15 | 63 |
Sep 2023 | 30 | 15 | 16 | 61 |
Aug 2023 | 27 | 13 | 15 | 55 |
Jul 2023 | 21 | 20 | 20 | 61 |
Jun 2023 | 17 | 33 | 20 | 70 |
May 2023 | 23 | 29 | 21 | 73 |
Apr 2023 | 34 | 15 | 25 | 74 |
Mar 2023 | 79 | 22 | 17 | 118 |
Feb 2023 | 34 | 23 | 11 | 68 |
Jan 2023 | 18 | 37 | 18 | 73 |
Dec 2022 | 18 | 27 | 10 | 55 |
Nov 2022 | 18 | 34 | 14 | 66 |
Oct 2022 | 17 | 58 | 24 | 99 |
Sep 2022 | 15 | 70 | 19 | 104 |
Aug 2022 | 16 | 19 | 12 | 47 |
Jul 2022 | 16 | 18 | 4 | 38 |
Jun 2022 | 36 | 41 | 3 | 80 |
May 2022 | 35 | 14 | 8 | 57 |
Apr 2022 | 15 | 22 | 12 | 49 |
Mar 2022 | 20 | 14 | 3 | 37 |
Feb 2022 | 12 | 16 | 4 | 32 |
Jan 2022 | 22 | 12 | 3 | 37 |
Dec 2021 | 32 | 25 | 7 | 64 |
Nov 2021 | 18 | 17 | 11 | 46 |
Oct 2021 | 18 | 18 | 12 | 48 |
Sep 2021 | 31 | 16 | 10 | 57 |
Aug 2021 | 35 | 12 | 1 | 48 |
Jul 2021 | 15 | 12 | 6 | 33 |
Jun 2021 | 12 | 14 | 3 | 29 |
May 2021 | 29 | 11 | 8 | 48 |
Apr 2021 | 28 | 15 | 6 | 49 |
Mar 2021 | 47 | 9 | 11 | 67 |
Feb 2021 | 54 | 2 | 4 | 60 |
Jan 2021 | 79 | 1 | 1 | 81 |
Dec 2020 | 37 | 0 | 3 | 40 |
Nov 2020 | 53 | 1 | 3 | 57 |
Oct 2020 | 95 | 2 | 1 | 98 |
Sep 2020 | 56 | 1 | 0 | 57 |
Aug 2020 | 79 | 0 | 5 | 84 |
Jul 2020 | 92 | 1 | 2 | 95 |
Jun 2020 | 35 | 6 | 6 | 47 |
May 2020 | 84 | 5 | 5 | 94 |
Apr 2020 | 340 | 11 | 18 | 369 |
Mar 2020 | 1259 | 4 | 12 | 1275 |
Feb 2020 | 1589 | 16 | 14 | 1619 |