title: Trauma-related impairment in children--a survey in Sri Lankan provinces affected by armed conflict.
abstract: OBJECTIVE
  The present study examined traumatic experiences, PTSD, and co-morbid symptoms in relation to neuropsychological and school performance in school children affected by two decades of civil war and unrest.
  
  
  METHODS
  The epidemiological survey of children's mental health included a representative sample of 420 school children. Local teachers were trained to administer a translation of the UCLA-PTSD Index Form. The instrument and the epidemiological findings were validated by assessment through clinical expert interview, school grades, and neuropsychological testing in a subsample (N=67).
  
  
  RESULTS
  Ninety-two percent of the children surveyed had experienced severely traumatizing events such as combat, bombing, shelling, or witnessing the death of a loved one. Twenty-five percent met the criteria for a diagnosis of PTSD. Traumatized children reported lasting interference of experiences with their daily life, which was corroborated by memory testing, scores in school performance and ratings of social withdrawal. Depressive symptoms and poor physical health were frequent in these children. The majority of trained teachers achieved valid results in the structured interviews.
  
  
  CONCLUSIONS
  Performance and functioning in children are related to the total load of traumatic events experienced. An important component of psychosocial programs in post-conflict areas should include increasing community-based awareness of the consequences of traumatic stress, both as a preventative measure and as a way of decreasing stigmatization of affected individuals.
authors.affiliation: University of Konstanz, Department of Psychology, Feuersteinstr. 55, Haus 22, D-78479 Reichenau-Lindenbühl, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Elbert
authors.forename: Maggie
authors.initials: M
authors.lastname: Schauer
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Schauer
authors.forename: Bianca
authors.initials: B
authors.lastname: Huschka
authors.forename: Michael
authors.initials: M
authors.lastname: Hirth
authors.forename: Frank
authors.initials: F
authors.lastname: Neuner