Growing evidence is reshaping understanding of how military service affects families long after a member leaves uniform. While increasing attention has focused on veterans and their partners, the experiences of children living in households affected by service-related injury, trauma and caregiving responsibilities remain under examined. This article explores how the way research defines and measures caregiving may be overlooking the full burden carried by military children and the implications this has for support, policy and future research.
Despite growing awareness of the harm faced by many children growing up in military families, their experiences continue to be ignored, minimised or misinterpreted. Often, research designed to highlight the challenges military children face contributes to the problem.
In 2024, the Elizabeth Dole Foundation produced a 319-page report called America’s Military and Veteran Caregivers: Hidden Heroes Emerging from the Shadows. The report identified that in America, there are approximately 2.3 million children under age 18 living with a veteran who requires caregiving and 40 per cent of these children took on caregiving duties. There are no equivalent reports in Australia, but given the similarities of military impacts on families, it is reasonable to extrapolate from this report into an Australian context.
Even though these figures show much higher rates of caregiving in military families than in other caregiving households, the way caregiving is defined, and data is interpreted in this report, potentially obscures the real numbers and significance of the burden being placed on children in these homes. If different questions were asked, and a more child-developmentally-aware lens applied to the findings, a much more worrying story about military children would be revealed.
How the report minimises military children impacts
The 2024 report defines caregiver burden as “the level of multifaceted strain perceived by the caregiver from caring for a family member and/or loved one over time.” Multifaceted strain in this context refers to the strain of neglecting of one’s own health, facing emotional and psychological distress, disruption in family function, constrained social activities, and economic consequences that can occur as a result of being a caregiver.
But despite this broad definition, and the study’s own finding that PTSD, major depressive disorders, other mental health conditions and alcohol and substance use disorder are the conditions most commonly attributed to military service, alongside stated awareness that the responsibilities of caregivers in military households often involve fewer basic functional tasks and more complicated-to-explain mental health support tasks such as helping someone cope with stressful situations, the following questions were used to determine whether someone qualified for recognition as a caregiver.
Please indicate if you provided any of the following types of assistance in the past 30 days to someone who has a wound, illness, injury or other condition for which they may need support:
- Personal care (for example, bathing, dressing, or feeding)
- Giving medicines or treatments
- Helping someone remember things that, due to a condition like a brain injury or dementia, they may be prone to forget
- Helping someone manage symptoms of psychological disorders (for example, depression, anxiety, or post-traumatic stress disorder)
- Helping arrange for medical or psychological services (for example, finding appropriate providers or making appointments)
- Providing transportation to medical or mental health appointments
- Helping getting in and out of beds and chairs
- Helping with other tasks which people with wounds, illness, or injuries may have difficulty performing themselves
- I do not currently provide any of these types of assistance, but I have in the past
- I have never provided any of these types of assistance to someone else.
These questions mainly focus on functional support. The granularity of detail used to describe (these functional supports) helping someone get out of beds and chairs, driving someone to appointments, helping arrange medical appointments is not applied to the category related to mental health support, the category most people have said constitutes the most significant part of their caregiving burden. This means that respondents are left to determine whether the care they give falls under the vague descriptor of “helping someone manage the symptoms of a psychological disorder.”
This seems a significant oversight in the study design, and one that has the potential to reduce the number of children identified as taking on a caretaking role.
Different questions different findings
A 2023 Australian study by May, Van Hooff, Doherty and Carter, published in the Journal of Child and Family Studies, included interviews with children aged 9 to 17 living with a military or emergency first responder parent with PTSD. It is the first study of its kind to ask children directly about their experiences. The study describes children who, alongside responsibilities such as supporting their parent’s medical needs, reminding their parent about treatment or checking in on their parent, also felt responsible for helping their parents avoid potential triggers as well as reducing the impact of PTSD symptoms on the affected parent or other family members, including younger siblings.
The report found children who were constantly worried about their parent, who concealed issues and denied their own needs and emotions in order to protect parents, and who felt guilt if they caused additional stress to their parents.
One child aged 14, when asked what they worry about, said: “Her not putting her mask on when she goes to sleep. Or her having a, not an episode, like a breakdown when I’m at school.” Another 17 year-old-said: “I didn’t want to also go and blurt out all my stuff about what (parent) was doing, and how (parent) was acting, because then that might bring more stuff to home. I didn’t want to put that on (parent), because that would make (parent) feel bad for making me feel bad. So, I kind of left it.
It is worth wondering what results might be revealed if different questions were asked, such as:
- Do you actively monitor the mood of someone in your household and change your behaviour to avoid upsetting them?
- Do you worry about someone’s triggers and take steps to help a person avoid them?
- Do you prioritise the needs of someone above your own and not ask for help so as not to be a burden?
- Do you worry about the wellbeing of someone in a way that impacts your emotional state, sleep or focus?
If this very broad statement of “helping someone manage the symptoms of a psychological disorder” was broken down into more specific detail in the same way as the more functional questions, the number of children in military households who are understood to be playing a caretaking role in the report may be significantly higher.
The issue with parents speaking on behalf of their child
Aside from the lack of specificity in the questions being asked about caregiving, another key issue with the study design was that children were not asked directly about their experiences. Instead, caregiver parents were asked to provide answers on behalf of their child, despite an established body of research showing that there are often discrepancies between parent’s and children’s perspectives on the child’s own experience.
For many reasons described below, the parent caregivers in this report are facing significant challenges of their own. They may not be aware, or have fully acknowledged to themselves, the extent of what their child is doing. Yet they are the sole source of data about whether their child is undertaking caregiving activities.
What counts as caregiving
In a separate chapter in the same report, children growing up in military/veteran caregiving households were found to be significantly more likely than children in non-caregiving households to be doing household tasks such as grocery shopping, cooking meals for the family and caring for younger siblings.
These children are sacrificing play and study in order to do the work required to take care of others. Yet, even these obvious caregiving contributions, that sustain the household, and give their other parent the capacity to attend to the injured veteran requiring support, isn’t defined as caregiving, according to the list of qualifying questions.
By this measure, if a child hands their parent medication, they are a caregiver. If they keep the household running so their mother can hand their father his medication, their efforts don’t constitute care.
This definitional gap about what counts as caregiving and who gets to speak about their experiences has real consequences. It determines how many children are counted, how they are resourced, and how the burden of their invisible systemic labour is valued and understood.
How caregiving impacts household functioning
To measure the impact caregiving stress has on household functioning, survey respondents were asked to indicate the degree to which they agreed with the following statements:
- Family members often put each other down.
- We fight a lot in our family.
- Family members sometimes get so angry they throw things.
The report found military/veteran caregiving households have a statistically significant increased risk of high household conflict when compared to all other groups surveyed, including caregiver households in civilian settings.
Alongside household conflict, household cohesion was similarly measured, based on responses to the following three statements:
- There is a feeling of togetherness in our family.
- Family members really help and support one another.
- We really get along well with each other.
Military/veteran caregivers were found to have significantly lower levels of household cohesion when compared with non-caregivers, though their levels on this score were similar to other caregiving households.
How caregiving impacts adult caregivers
The report identified that 75 per cent of adult caregivers in military and veteran families are under high perceived stress. 43 per cent of these caregivers meet criteria for probable depression, and 20 per cent have had recent suicidal ideation. In those whose caregiving includes concerns about suicide risk in the person they are caring for, 65 per cent meet criteria for excessive caregiver burden and hazardous drinking.
While the report focuses in most part on the adults in these households, it is worthwhile taking a moment to understand what is being described by the data from the perspective of children growing up in these homes.
What having two parents who are struggling means for miliary children
Children growing up in a military/veteran caregiving households are at increased risk of being exposed to family environments that are high on conflict, anger and disrespect, and low on togetherness and care. One of their parents has significant care needs, including a high likelihood of mental health and addiction issues. This parent may also be suicidal. Their other parent is likely to be highly stressed and depressed. In 20 per cent of cases they are also suicidal. If there is suicide risk in the veteran parent, 65 per cent of these caretaker parents are drinking alcohol to hazardous levels.
This means that many children in these homes do not have one, but two parents whose capacity to parent is compromised as they struggle with mental health and addiction. Instead of having a someone available to devote their time and energy to the developmental needs of the child, the child is taking on extra adult duties to support their parents.
These children are found to score significantly higher on emotional symptoms, negative mental health outcomes and conduct problems when compared with children in non-caregiving households. They have more problems at school and miss school at more than twice the rate of others due to illness.
The report found that compared to other populations, children in these homes were more likely to have needed mental health treatment in the past year but not received it. In what may seem like an unusual finding, when caregivers were asked to identify which services their child needed most, the most frequently identified unmet need, described by 28 per cent of caregiver parents, was that their children needed mentorship. The next highest identified need, at 21 per cent, was summer activities, such as camps. The report records these findings without analysing them, but they too warrant closer attention.
Children from military and veteran homes support others while being unsupported
The call for mentorship in this study seems to be a recognition by parents that more than specific mental health support, their child needs the kind of broad support, focused attention and helpful guidance that mentors provide. In most households this role falls to parents. But as the study describes, both parents in these households are often drowning in their own struggles. This doesn’t mean parents don’t love their child, but their ability to give their full energy and focus to their child is limited.
The desire of parents for their kids to have access to summer camps and activities can be read similarly. These activities are not only a way for parents to have some respite from child-based caretaking responsibilities. It is also an opportunity for a child to experience the freedom of being a child, in an environment that is fun instead of stressful.
The positive finding that may be a red flag rather than a silver lining
One of the pieces of data presented as a positive finding for the military-connected children described in this report, is that they present significantly higher on prosocial behaviours such as empathy, helpfulness and kindness. The fact that children are “more aware of others’ feelings” is presented as a silver lining rather than a red flag. This framing deserves serious scrutiny.
Being highly tuned to others is a trauma response
Many military/veterans requiring care in this report have traumatic brain injuries, and mental health conditions including PTSD. These invisible injuries are known to make people more unpredictable and volatile. They are also correlated with increased risk of anger and violence.
The National Child Traumatic Stress Network says that children growing up in homes that don’t feel safe, “may be overly sensitive to the moods of others, always watching to figure out what the adults around them are feeling and how they will behave. They may withhold their own emotions from others, never letting them see when they are afraid, sad, or angry.”
Being more aware of others feelings than your own is a hallmark of parentification
Veteran children growing up in households with PTSD-impacted parents describe increased hypervigilance and hyperawareness of the mood of their parent. They speak of childhoods spent “walking on eggshells.” Children of veterans with PTSD are three to six times more likely than the general population to develop PTSD themselves.
In the high-adversity households described in this report, with a high risk of both primary caregivers struggling with their mental health, being exquisitely attuned to the emotional states of others is a threat-management strategy. What is being identified as healthy prosocial behaviour also tracks against the fawn response, where children learn to please and appease in order to avoid harm or relationship disruption.
This learned behaviour can make children highly sensitive to the moods of others. But it must be remembered, other-orientation is also a central feature of the parentified child profile, a role-reversal dynamic where children provide emotional or practical support for their parents, rather than receiving it. The RAND report documents this dynamic, without considering the impact this can have on the development of the child.
Military children are very good at adapting to the needs of others and trying not to rock the boat. They may not present as children in crisis. That doesn’t mean they aren’t.
