Across contexts, the roles and responsibilities for children are shaped by a range of sociocultural factors; thus, a contextually specific exploration of adaptive functioning norms is important in optimizing the acceptability, effectiveness, and sustainability of mental health intervention and community programming. The current study aimed to examine child adaptive functioning behaviors for children in Cambodia, a country faced with continuing recovery efforts from war and genocide, intergenerational trauma transmission, poverty, and minimal access to health and mental health services. Qualitative interviews were conducted with 30 children (ages 10–13, 16 girls) and 30 caregivers (ages 30–62, 24 females) in the Battambang province of Cambodia receiving mental health services related to caregiver intimate partner violence. Results reveal trauma-affected children in Cambodia engage in a range of familial, occupational, social, religious, and academic functioning domains. Children in this sample reported behaviors that reflect policy and community level priorities of development of children as a societal and economic resource, distress management strategies of self and others informed by mental health therapy and local healing strategies, and engagement in religio-cultural Khmer Buddhist practices and ceremonies. Findings highlight the importance of contextually specific conceptualizations of functional impairment in guiding assessment and community program design and identifying areas for monitoring intervention effectiveness.
BerkvensJ. B. (2017). The importance of understanding culture when improving education: learning from Cambodia. International Education Studies, 10(9), 161–174.
3.
BerryJ. W. (1976). Human ecology and cognitive style: Comparative studies in cultural and psychological adaptation. Sage/Halsted/Wiley.
4.
BerryJ. W.PoortingaY. H.SegallM. H.DasenP. R. (2002). Cross-cultural psychology: Research and applications (2nd ed.). Cambridge University Press.
5.
BertrandD. (2005). The therapeutic role of Khmer mediums (kru borameï) in contemporary Cambodia. Mental Health, Religion & Culture, 8(4), 309–327.
6.
BirdH. R.GouldM. S. (1995). The use of diagnostic instruments and global measures of functioning in child psychiatry epidemiological studies. In VerhulstF. C.KootH. M. (Eds.), The epidemiology of child and adolescent psychopathology (pp. 86–103). Oxford University Press.
7.
BraunV.ClarkeV. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.
8.
CatchpoleR. E.BrownlieE. B. (2016). Characteristics of youth presenting to a Canadian youth concurrent disorders program: Clinical complexity, trauma, adaptive functioning and treatment priorities. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 25(2), 106–115.
9.
CauceA. M.Domenech-RodríguezM.ParadiseM.CochranB. N.SheaJ. M.SrebnikD.BaydarN. (2002). Cultural and contextual influences in mental health help seeking: A focus on ethnic minority youth. Journal of Consulting and Clinical Psychology, 70(1), 44–55.
10.
ChhimS. (2013). Baksbat (broken courage): A trauma-based cultural syndrome in Cambodia. Medical Anthropology, 32(2), 160–173.
11.
CollinsW. (2000). Medical practitioners and traditional healers: A study of health seeking behavior in Kampong Chhnang. Centre for Advanced Study, Phnom Penh, (for HETF, MoH/WHO). www.cascambodia.org
12.
CollinsC. S.StocktonC. M. (2018). The central role of theory in qualitative research. International Journal of Qualitative Methods. https://doi.org/10.1177/1609406918797475
13.
CormackD. (1997). Killing fields, living fields. OMF International.
14.
DangH. M.WeissB.TrungL. T. (2016). Functional impairment and mental health functioning among Vietnamese children. Social Psychiatry and Psychiatric Epidemiology, 51(1), 39–47.
15.
FiggeC. J.Martinez-TorteyaC.BogatG. A.LevendoskyA. A. (2018). Child appraisals of interparental conflict: The effects of intimate partner violence and parent–child relationship quality. Journal of Interpersonal Violence. https://doi.org/10.1177/0886260518794509
16.
FiggeC. J.Martinez-TorteyaC.TaingS.ChhimS.HintonD. E. (2020a). Key expressions of trauma-related distress in Cambodian children: A step toward culturally sensitive trauma assessment and intervention. Transcultural Psychiatry. https://doi.org/10.1177/1363461520906008
17.
FiggeC. J.Martinez-TorteyaC.TaingS.ChhimS.HintonD. E. (2020b). Local clinician perspectives on cause, impact, and treatment of key expressions of distress in Cambodian children. Transcultural Psychiatry. https://doi.org/10.1177/1363461520905995
18.
FilmerD.SchadyN. (2008). Getting girls into school: Evidence from a scholarship program in Cambodia. Economic Development and Cultural Change, 56(3), 581–617.
19.
FuluE. (2015). WHO, UN Women Cambodia, and Royal Government of Cambodia 2015 National Survey on Women’s Health and Life Experiences in Cambodia (Report). Phnom Penh.
20.
HardingJ. (2018). Qualitative data analysis: From start to finish. SAGE.
21.
HillC. E. (2012). Consensual qualitative research: A practical resource for investigating social science phenomena. American Psychological Association.
22.
HintonD. E.BarlowD. H.ReisR.de JongJ. (2016). A transcultural model of the centrality of “thinking a lot” in psychopathologies across the globe and the process of localization: A Cambodian refugee example. Culture, Medicine, and Psychiatry, 40(4), 570–619.
23.
HintonD. E.HintonA. L.EngK. T.ChoungS. (2012). PTSD and key somatic complaints and cultural syndromes among rural Cambodians: The results of a needs assessment survey. Medical Anthropology Quarterly, 26(3), 383–407.
24.
HintonD.HintonS.UmK.CheaA.SakS. (2002). The Khmer ‘weak heart’ syndrome: Fear of death from palpitations. Transcultural Psychiatry, 39(3), 323–344.
25.
HintonD. E.PichV.ChheanD.PollackM. H.McNallyR. J. (2005). Sleep paralysis among Cambodian refugees: Association with PTSD diagnosis and severity. Depression and Anxiety, 22(2), 47–51.
26.
HintonD. E.ReisR.de JongJ. (2015). The “thinking a lot” idiom of distress and PTSD: An examination of their relationship among traumatized Cambodian refugees using the “thinking a lot” Questionnaire. Medical Anthropology Quarterly, 29(3), 357–380.
27.
HintonD. E.ReisR.de JongJ. (2019). Ghost encounters among traumatized Cambodian refugees: Severity, relationship to PTSD, and phenomenology. Culture, Medicine, and Psychiatry, 44(5), 1–27.
28.
HintonD. E.SeponskiD. M.KhannS.ArmesS. E.LaharC. J.KaoS.SchunertT. (2019). Culturally sensitive assessment of anxious-depressive distress in the Cambodian population: Avoiding category truncation. Transcultural Psychiatry, 56(4), 643–666.
29.
HirschfeldR.MontgomeryS. A.KellerM. B.KasperS.SchatzbergA. F.MöllerH. J.HealyD.BaldwinD.HumbleM.VersianiM.MontenegroR.BourgeoisM. (2000). Social functioning in depression: A review. The Journal of Clinical Psychiatry, 61(4), 268–275.
30.
HoltJ. C. (2012). Caring for the dead ritually in Cambodia. Southeast Asian Studies, 1(1), 3–76.
31.
ItoH.SetoyaY.SuzukiY. (2012). Lessons learned in developing community mental health care in East and South East Asia. World Psychiatry, 11(3), 186.
32.
KentA. (2006). Reconfiguring security: Buddhism and moral legitimacy in Cambodia. Security Dialogue, 37(3), 343–361.
33.
KentA. (2007). Purchasing power and pagodas: The Sīma monastic boundary and consumer politics in Cambodia. Journal of Southeast Asian Studies, 38(2), 335–354.
34.
KerigP. K.SwansonJ. A. (2010). Ties that bind: Triangulation, boundary dissolution, and the effects of interparental conflict on child development. In SchulzM. S.PruettM. K.KerigP. K.ParkeR. D. (Eds.), Decade of behavior (science conference). Strengthening couple relationships for optimal child development: Lessons from research and intervention (pp. 59–76). American Psychological Association. https://doi.org/10.1037/12058-005
35.
KinsethA. S. (2009, September). Unspoken trauma: Breaking the silence to Heal Cambodia’s youth. In ISA-West annual conference “Human Consequences of State Political Action,”San Francisco, CA.
36.
KjelgaardM. M.Tager-FlusbergH. (2001). An investigation of language impairment in autism: Implications for genetic subgroups. Language and Cognitive Processes, 16(2–3), 287–308.
37.
KwonS.KeoL. (2019). Social health protection in Cambodia: Challenges of policy design and implementation. International Social Security Review, 72(2), 97–111.
38.
MacfieJ.HoutsR. M.McElwainN. L.CoxM. J. (2005). The effect of father–toddler and mother–toddler role reversal on the development of behavior problems in kindergarten. Social Development, 14(3), 514–531.
39.
McKnightP. E.KashdanT. B. (2009). The importance of functional impairment to mental health outcomes: A case for reassessing our goals in depression treatment research. Clinical Psychology Review, 29(3), 243–259.
40.
MerriamS. B. (2009). Qualitative case study research qualitative research: A guide to design and implementation (pp. 39–54). Jossey-Bass.
41.
Ministry of Women’s Affairs, UNICEF Cambodia, US Centers for Disease Control and Prevention. (2014). Findings from Cambodia’s violence against children survey: Summary. Ministry of Women’s Affairs.
42.
MorrisC. (2000). Peacebuilding in Cambodia: The role of religion. Peacemakers Trust. ca/research/Cambodia, 12.
43.
MurrayL. K.DorseyS.HarozE.LeeC.AlsiaryM. M.HaydaryA.WeissW. M.BoltonP. (2014). A common elements treatment approach for adult mental health problems in low-and middle-income countries. Cognitive and Behavioral Practice, 21(2), 111–123.
44.
PalermoT. M.LongA. C.LewandowskiA. S.DrotarD.QuittnerA. L.WalkerL. S. (2008). Evidence-based assessment of health-related quality of life and functional impairment in pediatric psychology. Journal of Pediatric Psychology, 33(9), 983–996.
45.
PiquemalN. (2017). Educational experiences and opportunities in rural Cambodia: Families and youth’s voices. Vulnerable Children and Youth Studies, 12(4), 317–327.
46.
PottickK. J.LermanP.MicchelliM. (1992). Of problems and perspectives: Predicting the use of mental health services by parents of urban youth. Children and Youth Services Review, 14(3–4), 363–378.
47.
PurgatoM.TedeschiF.BetancourtT. S.BoltonP.BonettoC.GastaldonC.GordonJ.O’CallaghanP.PapolaD.PeltonenK.PunamakiR. L.RichardsJ.StaplesJ. K.UnterhitzenbergerJ.de JongJ.JordansM. J. D.GrossA. L.TolW. A.BarbuiC. (2019). Mediators of focused psychosocial support interventions for children in low-resource humanitarian settings: Analysis from an individual participant dataset with 3,143 participants. Journal of Child Psychology and Psychiatry, 61(5), 584–593. https://doi.org/10.1111/jcpp.13151
48.
PurgatoM.UphoffE.SinghR.PachyaA. T.AbdulmalikJ.van GinnekenN. (2020). Promotion, prevention and treatment interventions for mental health in low-and middle-income countries through a task-shifting approach. Epidemiology and Psychiatric Sciences, 29, e150. https://doi.org/10.1017/S204579602000061X
49.
RanaS.ArdichviliA.TaingS. K. (2017). National human resource development in a transitioning society: The case of Cambodia. Human Resource Development International, 20(2), 127–146.
50.
RGC (Royal Government of Cambodia). (2015). National employment policy 2015–2025. Government Printing Office.
51.
RodriguezP.HolowkaD. W.MarxB. P. (2012). Assessment of posttraumatic stress disorder-related functional impairment: A review. Journal of Rehabilitation Research and Development, 49(5), 649–666.
52.
SchalockR. L.Borthwick-DuffyS. A.BradleyV. J.BuntinxW. H.CoulterD. L.CraigE. M.GomezS. C.LachapelleY.LuckassonR.ReeveA.ShogrenK. A.SnellM. E.SpreatS.TasséM. J.ThompsonJ. R.Verdugo-AlonsoM. A.WehmeyerM. L.YeagerM. H. (2010). Intellectual disability: Definition, classification, and systems of supports. American Association on Intellectual and Developmental Disabilities.
53.
ScharpfF.KyaruziE.LandoltM. A.HeckerT. (2019). Prevalence and co-existence of morbidity of posttraumatic stress and functional impairment among Burundian refugee children and their parents. European Journal of Psychotraumatology, 10(1), 1676005.
54.
SchunertT. (2012). Cambodian mental health survey 2012. Royal University of Phnom Penh, Department of Psychology.
55.
ScottJ.TeasdaleJ. D.PaykelE. S.JohnsonA. L.AbbottR.HayhurstH.MooreR.GarlandA. (2000). Effects of cognitive therapy on psychological symptoms and social functioning in residual depression. The British Journal of Psychiatry, 177(5), 440–446.
56.
ShultzE. L.HoskinsonK. R.KeimM. C.DennisM.TaylorH. G.BiglerE. D.RubinK. H.VannattaK.GerhardtC. A.StancinT.YeatesK. O. (2016). Adaptive functioning following pediatric traumatic brain injury: Relationship to executive function and processing speed. Neuropsychology, 30(7), 830–840.
57.
StrasserJ.ChhimS.TaingS. (2017). Narrative exposure therapy (NET): Culturally sensitive trauma treatment for Khmer Rouge survivors. Journal of the International Association of Buddhist Universities (JIABU), 7(1), 100–104.
58.
TanC. (2007). Education reforms in Cambodia: issues and concerns. Educational Research for Policy and Practice, 6(1), 15–24.
59.
TolW. A.KomproeI. H.JordansM. J.SusantyD.De JongJ. T. (2011). Developing a function impairment measure for children affected by political violence: A mixed methods approach in Indonesia. International Journal for Quality in Health Care, 23(4), 375–383.
60.
TolW. A.KomproeI. H.ThapaS. B.JordansM. J.SharmaB.De JongJ. T. (2007). Disability associated with psychiatric symptoms among torture survivors in rural Nepal. The Journal of Nervous and Mental Disease, 195(6), 463–469.
61.
Van de PutW. A. C. M.EisenbruchM. (2004). Healing trauma in Cambodian communities. In K. Miller & L. Rasco (Eds.), From clinic to community: Ecological approaches to refugee mental health (pp. 133–159). Lawrence Erlbaum.
62.
Van SchaackB. (2011). Cambodia’s hidden scars: Trauma psychology in the wake of the Khmer Rouge: An edited volume on Cambodia’s mental health. Documentation Center of Cambodia.
63.
VelingW.HallB. J.JoosseP. (2013). The association between posttraumatic stress symptoms and functional impairment during ongoing conflict in the Democratic Republic of Congo. Journal of Anxiety Disorders, 27(2), 225–230.
64.
WintersN. C.CollettB. R.MyersK. M. (2005). Ten-year review of rating scales, VII: Scales assessing functional impairment. Journal of the American Academy of Child & Adolescent Psychiatry, 44(4), 309–338.
65.
YiS.PoudelK. C.YasuokaJ.YiS.PalmerP. H.JimbaM. (2013). Exposure to violence in relation to depressive symptoms among male and female adolescent students in Cambodia. Social Psychiatry and Psychiatric Epidemiology, 48(3), 397–405.
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