Disaster Relief and Crisis Counseling

Psychosocial Issues for Children
and Adolescents in Disasters

THE WORLD OF CHILDHOOD AND THE DEVELOPING CHILD

Children are one of the most vulnerable groups during and following a disaster. A disaster is a strange event that is not easily understood. It is emotionally confusing and frightening and results in children needing significant instrumental and emotional support from adults. Children, parents, and whole families in need of assistance are found at shelters, recovery centers, and other locations. A review of some basic principles and reminders from child developmental theory show how a child's current stage of development influences their behavior and their understanding of traumatic events associated with the disaster. Below is a list of basic principles that may be helpful as we, the helpers, are rapidly trying to determine the best strategy for providing assistance to children in both the early stages of crisis response and the later stages of emotional recovery from the disaster:

Be a supportive listener. Be sensitive to the child's cultural, ethnic, and racial experiences.

Respond in a way that is consistent with the child's level of development.

Be aware of the child's emotional status. Is the child actively afraid or withdrawn?

Determine if the child is comfortable/secure about his/her current surroundings and those of his or
her parents, and other significant persons/pets,

Assist the child in normalizing his/her experiences.

Seek assistance from a child specialist or mental health professional, if necessary. Assistance is needed when the helper does not know what to do or think or if he or she is making things worse.

THEORIES OF CHILD DEVELOPMENT

An abundance of popular press is available on the subject of children. Topical areas of interest include how to raise, parent, educate, and discipline children. It is important, especially when one is in a period of stress and turmoil, to step back from the issues at hand and assess the current situation from the perspective of life during non-crisis routine times. This is especially true when engaging children.

The most important concept to remember is that children are different from adults; childhood is different from adulthood. As trained child health workers or disaster mental health outreach workers who encounter children as survivors of a disaster, the preceding statement seems with a moment's reflection as obvious. In fact, the reality is so obvious that it is often overlooked.

Jean Piaget, renowned for his elegant theory of child development, formulated much of his theory from simply observing how his own children responded to their environment. Piaget, the scientist-observer, systematically confronted his children at different chronological ages with various mental challenges and recorded his observations of their responses. Classic examples from his work illustrate how children perceive the world differently at various chronological ages.

Piaget (Flavell, 1963) noted young children have difficulty observing objects from more than one perspective. For example, a seven-year-old is shown two glass containers: one is short, wide, and filled with water; the other is empty, tall, and slim in shape. The child is convinced that when the liquid from the short container is transferred to the tall one, the volume of the contents actually changes as well. Similarly, when a child of ten or eleven is asked to solve a problem that requires abstract reasoning, such as a problem of logical inference (i.e., a>b and b>c; therefore, a>c), the child is often baffled by the solution. However, when the same problem is presented with solid objects, it is easily solved. Because the objects are concrete and readily visible, he or she easily recognizes the relationship. An adolescent, on the other hand, can solve this problem in the "abstract" by creating mental images of a, b, and c and then solving the problem in his or her head.

Piaget was trained as a biologist and based much of his theory of development on the notion that organisms seek homeostasis or a steady state of balance or equilibrium. With respect to humans, he postulated that as we grow we change internally and thus, our capacity to engage the environment changes as well. Throughout our development we experience states of disequilibrium and seek to return to a state of equilibrium. The mechanisms he proposed are two active processes of assimilation and accommodation. Simply put, assimilation is the process of interpreting new information within the context of our existing cognitive structure, while simultaneously accommodating to the new information or demands of our environment. Through the tension of these two ongoing processes we develop our cognitive knowledge and capacities. Thus, we develop from an infant who responds primarily to sensations to an adult who is capable of complex abstract reasoning.

All of us can recall conversations with friends who related their frustration as parents, complaining that their children are disobedient and refuse to do their chores. Is this refusal to behave and do the chores simply because the child is disobedient? Or is it because the parent is issuing commands in a manner that requires the child to translate the "abstract" orders into concrete actions, when they have not yet developed the necessary cognitive skills? While a comprehensive discussion of cognitive developmental theories is beyond the scope of the subject at hand, it is important to recognize that children think and construct their responses to the world in different ways depending on their current level or stage of cognitive development.

In summary, we should be aware when we meet a child that they are operating in the world with a different set of cognitive structures than adults and are interpreting information from the environment in a different fashion. In the next chapter, there are a number of illustrations of how this actually works.

Cosario (1997) recently reasserted that when trying to understand children, we must remember that childhood is not simply an apprenticeship to the "real" world of adulthood, but is the current world in which children operate. It is the environment in which cognitive, social, and emotional development occur for individual children. "Children create and participate in their own unique peer cultures by creatively taking or appropriating information from the adult world to address their own peer concerns" (p.18). Hartup (1979) suggests that children really experience two worlds: the world of adult-child interactions, such as with teachers and parents, and the world of peer interactions with children of similar age. We must be aware of the simultaneous presence of both these environments to understand and relate to children as developing individuals.

The emotional development of children parallels, complements, and interacts with their cognitive development. Kagan (1982) has shown in studies of normal infant development that when confronted with new and different information infants may smile if the information is successfully integrated, and they show fear by crying or withdrawing if they cannot make sense of the information. The study of emotional development affirms that emotions are central to survival. Through emotional expression the infant expresses distress (a soiled diaper or hunger), pleasure (being comfortable and having a full stomach), and fear of strangers. As children in middle school and high school, we learn to respect the social standard of non-aggression toward peers and acquire the skills necessary to problem solve conflicts and modulate emotional expression accordingly. By adolescence we are well skilled in expressing empathy, pride, shame, guilt, and other emotions. Thus, throughout normal development we learn more sophisticated strategies of emotional expression.

Closely tied to emotional development is the development of attachment. Attachment theory as originally developed by John Bowlby (1982) integrates psychoanalytic concepts of child development with parts of cognitive psychology, ethnology, and human information processing. He defines attachment theory as a way of conceptualizing ". . . the propensity of human beings to make strong affectional bonds to particular others, and of explaining the many forms of emotional distress and personality disturbance including anxiety, anger, depression, and emotional detachment to which unwilling separation and loss give rise" (Bowlby, 1982, p. 39). Attachment refers to the affectional bond that forms between a nurturing figure, usually the mother, and her child in the course of time and in response to consistent care. Bowlby states that there is an innate tendency within the human baby to seek and maintain proximity to the attachment figure. This behavior has the function of protecting children from the risk of harm.

Mary Main (1996) recently reviewed the field of attachment research. In the years since Bowlby's original formulation, the concept of attachment has been extended beyond infancy to account for behavior throughout the life span. Main has affirmed that the development of the attachment relationship is based on social interaction. In the overwhelming majority of instances children become securely attached to a nurturing caregiver. Children also become attached to maltreating parents and the resulting attachment bond is expressed as an insecure attachment. The quality of the attachment bond is usually established by seven to eight months of age and is characterized as secure or insecure. Secure attachment is the result of an infant being able to rely on the caregiver as consistently available and nurturing. Infants who have incompetent, uncaring, or inconsistent caregivers express insecure attachment behavior. Insecure attachment behaviors related to separation and reunion with the caregiver range from ignoring the caregiver to excessive and disquieting expressions of distress.

Being securely attached to a nurturing caregiver is further expressed by using the caregiver as a "secure base" for exploring one's immediate environment. For example, a small child playing in the park will run and play far away from his or her mother as long as he or she is in visual proximity. The child will wander farther and farther away only to spontaneously return to his or her mother and soon wander off again in spirited play. Just as the child displays organized and confident behaviors while in the comforting presence of the caregiver, he or she can also appear disorganized and highly anxious or fearful upon separation or loss of the caregiver. Brief separations from one's parents is a common event in disasters.

Upon separation and loss of proximity to the caregiver, the child will express fear and anxiety until again secure in the knowledge of the availability of the caregiver. As discussed earlier, infants and very young children must be able physically to see objects to keep them psychologically available. However, with time, children can build psychological representations of objects, people, and relationships. Recent research suggests that through maintenance of mental models of caregivers, children are influenced in their formation of relationships with peers and in the development of successful interactions with friends. In a similar vein, adolescents are influenced by models of adult caregivers as they begin developing long-term relationships with significant others.

To better understand normal and abnormal child development, much research has been conducted comparing the behavior of securely attached and insecurely attached children. Carlson and Sroufe (Main, 1996) have reported ". . . in peer and school settings, children who felt secure as infants with their mother exhibit greater ego resilience as well as social and exploratory competence than insecure infants . . . Security with fathers also contributes favorably to outcome" (p. 240).

Disasters are events postulated with separation and loss. Irrespective of the quality of the child's attachment to the caregiver as secure or insecure, unexpected separation and disruption of one's secure environment results in fear, anxiety, and disorganization of one's own behavior. Children who have experienced secure attachment relationships with a nurturing caregiver are the most resilient in reconciling the disruption and recovering from traumatic events. The disruption and loss experienced will most likely be more difficult to resolve for children who have experienced insecure attachment relationships.

Cassidy (1996) summarized some basic findings from the study of attachment relationships: Linkages exist between family and peer systems.

Children's daily experiences with parents affect their concept of self and relationships with others.

Children with more positive relationships with peers express more positive behaviors.

More positive behaviors result in being better liked by peers.

In summary, the quality of parents' caregiving behavior initiates a process linked with the quality of peer relationships throughout childhood and early adolescence.

Erik Erickson's theory of psychosocial development (Santrock and Yussen, 1987) offers a perspective on a child's social development. Erickson proposed that social development is the result of the interaction between internal biological forces and external cultural pressures. As such, he proposed eight stages of development throughout the life span. The conflicts one experiences at each stage can be resolved in either a positive (adaptive) or negative (mal-adaptive) way. For Erickson, the development of a psychologically healthy adult required the successful resolution of conflict at each developmental stage. He accounted for variation of emotional expression and behavior among individuals on their resolution of conflict along a continuum of healthy to unhealthy outcomes. The eight stages of psychosocial development coincide loosely with eight life stages. Five of these stages occur from infancy through adolescence.

Early infancy is the stage of 'trust versus mistrust' in which the infant learns to view the world as a place where one can trust others to be supportive and caring, or a place where the infant cannot consistently rely on the support and nurturing of others. Late infancy is the stage of 'autonomy versus shame and doubt'. In this stage autonomy is the ability to control one's own actions, such as successful toileting. An inability to learn such control may result in feelings of shame and doubt. Early childhood is the stage of 'initiative versus guilt'. The child is confronted with the conflict of relationships with parents and unresolved feelings of love and hate. Taking the initiative and engaging in positive social activities resolves conflict; failure to do so results in unresolved guilt. Middle childhood is the stage of 'industry versus inferiority'. During this stage, the child's cognitive knowledge, physical abilities, and social relationships are expanded. Upon comparison of self with others, the child ultimately measures how he or she compares to peers. If the child feels incompetent and inferior, as opposed to competent and adequate, his or her interactions with others will differ than if the child feels confident in how he or she compares with peers. During the storm and stress of adolescent years, the child is confronted with the universally known stage of Erickson's theory 'identity versus identity confusion'. It is during this period that the child resolves the conflict between "who I am and what I want to be" and struggles to decide the direction of his or her life. Resolution of the conflict associated with identity marks the end of childhood and the emergence of adult role-taking in society. The remaining three stages continue to deal in a similar vein with issues of role performance and development throughout adulthood.

In summary, normative development throughout childhood is generally viewed as an active and complex process. It involves the ongoing maturation of the child and how he or she engages people and events, attachment to significant adults, social relationships with peers, intellectual and emotional development, and the actual world in which he or she lives. Childhood is the culture in which individual development occurs. The quality and characteristics of their environment also directly influence the healthy development of children. Is it a setting where basic needs are a struggle to meet, where danger and fear of personal safety are daily concerns? Or is it a world that is predictable in its organization and resources? Is it a nurturing place with companionship or one of disregard and isolation?

When a natural or human-caused disaster invades the world of the child, the impact disrupts the normalcy of the environment and normative functioning. Fortunately, most children enjoy successful and normal childhoods surrounded by adults and peers who can help them adjust to the impact of the disaster. Traumatic events can be successfully assimilated into their worlds within the context of their own individual development. For those children who are experiencing childhood as a negative environment and are actively developing maladaptive survival strategies, recovery from traumatic events will be a complex and time-consuming process. This can result in sustained and significant alterations in how successfully children are functioning in their world. For example, children may experience a drop in academic performance at school and disruptions in their social interactions with friends, siblings, or parents. Children who are experiencing such significant disruptions in their routine social and cognitive functioning may be at risk for developing Post Traumatic Stress Disorder (PTSD) or another form of emotional disorder.