LAUSR

OBJECTIVE While the psychological effects of military service on the children of active-duty personnel have been studied extensively, little is known about the potential effects of military service for children of veterans after service has ended. METHOD Using nationally-representative data from the 2018-2019 National Survey of Children's Health (NSCH), we compare the school-age children of veteran families (n=4,028) to those of non-veteran families (n=38,228). Due to large sample sizes, effect sizes (relative risk and Cohen's d), rather than p values, were used to identify substantial differences in caregiver-reported sociodemographic, clinical, and school performance factors between children and caregivers in families with and without a veteran caregiver. Multivariate analyses were used to adjust for socio-economic factors that could increase health service use. RESULTS Children of veteran families were more likely to have higher family incomes, health insurance, and married caregivers but are also reported to have higher rates of clinically-recognized externalizing behavioral conditions (ADD/ADHD or conduct) (17.6% vs. 12.7%, relative risk, 1.42; 95% confidence intervals (CI), 1.21-1.66) and adverse childhood experiences; but no substantial differences in clinically-recognized anxiety or depression. After adjustment for potentially confounding factors, children in veteran families were still more likely to be reported to have externalizing problems (odds ratio, 1.34; 95% CI, 1.02-1.77). CONCLUSION After adjustment for socio-economic advantages that may increase health service use, children of veteran families demonstrate substantially higher rates of clinically-recognized externalizing problems. While explanations for this require further study, service systems working with veterans may consider integrating child-focused screening/services.