PTSD in Lebanese children

The following is a sample Paper 3 that looks at a case study. Below you will first find the stimulus piece, followed by the static questions.  A copy of the mock paper is included to give students as an in-class assessment.

Potential answers are included in the hidden boxes below.

Student copy

Stimulus piece

Macksoud & Aber (1996) carried out a case study on children in a Lebanese neighbourhood following the end of the Lebanese civil war. The researchers wanted to see how different types of trauma experienced during the war affects the development of children.

A sample of 224 Lebanese children (10–16 years old) was interviewed.  The sample was drawn from three communities that had witnessed high levels of violence during the war. To obtain participants, an ad was put into the local newspaper. The ad promised that all participants would have a psychological examination and receive treatment advice.  The interviews used standardized questions to measure the children’s level of war exposure, mental health symptoms and Post-Traumatic Stress Disorder (PTSD). In addition, parents were interviewed to employ data triangulation. In addition, the researchers observed the children in different social situations including interactions at school, on the playground, and at home with their families.

The number and type of the children's war traumas varied with their age, gender, father's occupational status and mother's educational level.

Results indicated that on average a Lebanese child had experienced five to six different types of war related traumatic events during his or her lifetime, and some events were experienced several times. Exposure to shelling or combat, displacement, extreme poverty and witnessing violent acts were the most common traumatic experiences faced by the children. As predicted, the number of war traumas experienced by a child was positively related to PTSD symptoms. In addition, the type of trauma may also affect their problem-solving skills, ability to adapt, or general mental health. For example, children who lost a family member became victims of violent acts, witnessed violent acts, and/or were exposed to shelling or combat exhibited more PTSD symptoms. Children who were separated from parents reported more depressive symptoms. Children who were displaced from their homes demonstrated more concern for their futures. Lastly, children who were separated from parents and who witnessed violent acts, in fact, showed more pro-social behavior.

Questions

1a. Identify the method used and outline two characteristics of the method.

A case study is an in-depth study of an individual or a group. Case studies often rely on several different methods (method triangulation) - interviews, observations, surveys, etc. A case study also often makes use of school records, reports from friends and family, or archival information like diaries. (data triangulation).  Case studies also look at an individual or group more holistically, looking at a range of variables, rather than a single variable. It would be appropriate for this study because the researchers are looking to describe the wide range of behaviour exhibited by the children and determine if there are any trends. It is also appropriate because it does not rely solely on the self-reported data of the children, but includes observations and information from families and schools. Although case studies often look at an individual or group over a long period of time (longitudinally), that was not the case in this study.

1b. Describe the sampling method used in the study.

The sample was a voluntary sample in that there was an advertisement placed in the newspaper.  However, the communities in which the advertisements were placed were chosen by the researchers based on the "level of violence" that was experienced. It is not clear from the stimulus piece how this was determined.  As an incentive for participation, the participants were promised a psychological examination and advice.  This may lead to ascertainment bias - that is, the sample may result in a bias where the participants are made up of families with concerns for their child's mental health and exclude children that do not seem to have any problems and perhaps were more resilient.

1c. Suggest an alternative or additional research method giving one reason for your choice.

Based on the findings of the study, the researchers may want to give a questionnaire to the wider community or to other communities in Lebanon in order to determine the extent to which the results could be generalized.  A questionnaire would be a quicker way to gather a large amount of data - and it would allow the participants to be anonymized.  Other possibilities would be to simply do focus groups with families or to carry out naturalistic observations in schools to observe children's behaviours.

2. Describe the ethical considerations that were applied in the study and explain if further ethical considerations could be applied.

This study is a bit problematic because children are the participants.  However, the goal of the study is to help understand and potentially treat children whose psychological well being has suffered because of war.  Consent would have been needed from the parents.  Since this was a volunteer sample, consent would have been rather easily obtained.  Consent would have to include the guarantee of anonymity for the children and family and a clear understanding of how the information would be used. Considering that this was a community that had recently experienced conflict, if anonymity were not guaranteed, there could be problems for the families.  The families would have the right to withdraw at any point and they would have to be debriefed at the end of the study.  In this case, as promised, they would have to give the families advice based on the findings with regard to their children.  The questions asked during the interviews could ask the participants to recall traumatic memories from the war.  Although this is not a problem since the individuals were informed that this would be part of the study before they began, if a participant were hesitant to share about the experience, the researcher should not apply pressure for the individual to discuss the memory. The researchers should also be empathetic to the participants and recognize if and when the interviews are too stressful for the children and then terminate the interviews so that the child does not experience undue stress.

3. Discuss how the researcher may avoid bias in this study.

The researchers could practice reflexivity. Reflexivity involves the researcher documenting his or her beliefs, attitudes, values, theoretical position and reactions to the study and assessing the likely impact of these on the collection and analysis of data. It is particularly important here because of the political nature of the study. The researcher should identify if s/he is Lebanese, had children affected by the conflict, or is politically active on one of the sides of the conflict. It is important that the researcher discloses this information as well as reflects on how this may have played a role in his/her interpretation of the data. It is possible that a researcher who is heavily invested in the conflict may not be objective and may experience researcher bias - for example, seeing symptoms of PTSD where none is to be found.

The sample is problematic and may be a result of researcher bias.  Having chosen these communities based on their "level of conflict during the war" could be subjective.  Also, promising treatment may also bias the sample.  These choices by the researcher may have resulted in more extreme cases being chosen for the study. Choosing a more objective sampling method may have lowered the chance of bias.

Another way to avoid bias is to use researcher triangulation.  This is when there are several researchers that carry out the study individually and then the data is compared.  In this case, several researchers could carry out the observations of then compare their notes to see if their observations are similar.  The tests could also be given blindly so that the researcher does not know which child's test is being scored.  In this way, they are not "reading into" responses based on their experience with the child. Finally, the researcher could share their interpretations with the parents to see if they feel that they fairly represent their child's behaviour.  By trying to establish the credibility of their findings, the researcher lowers the potential for bias. 

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