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Disaster Relief and Crisis Counseling
Psychosocial Issues for Children
and Adolescents in Disasters
REACTIONS OF CHILDREN TO DISASTERS
NORMAL REACTIONS TO
DISASTER INDUCED STRESS
Most parents recognize when their children's behavior indicates emotional distress. During routine, non-crisis times parents are tuned-in to the nuances of their children's behavior. Most mothers can tell immediately if their young son or teenage daughter had a bad day at school or a fight with their best friend. A very common sign indicating distress is the sudden appearance of a very busy child, who just suddenly decides he or she will watch TV with his or her parents, and is not even particular about what they are watching. For most parents, this is when their antennae go up and somehow they know it is time to give that extra hug and just be available. Typically, a few words eventually pass between the parent and child. The parent smiles, the child looks relieved, and as quickly as the child appeared he or she vanishes back into his or her now somewhat reorganized and normal world. Under normal circumstances in the majority of nurturing families, they play this scene over and over and without really thinking anything of it. It is just a slice of daily life.
Disasters are not normal or routine and therefore, impose a significant abnormality on our daily routines. Everyone is affected. Typical modes of interacting with each other are strained. All of us are trying to get a grip on things and as a result focus less on supporting each other. It is within this context that children experience the aftermath of disasters.
The American Academy of Child and Adolescent Psychiatry (AACAP, 1998) suggests that a child's reaction to a disaster, such as a hurricane, flood, fire, or earthquake, depends upon how much destruction is experienced during or after the event. The death of family members or friends is the most traumatic, followed by loss of the family home, school, special pets, and the extent of damage to the community. The degree of impact on children is also influenced by the destruction they experience second hand through television and other sources of media reports.
Generally, most children recover from the frightening experiences associated with a disaster without professional intervention. Most simply need time to experience their world as a secure place again and their parents as nurturing caregivers who are also again in charge.
Studies of how children have reacted to catastrophic events are limited. However, in the available work done on this topic there emerges a consistent pattern of responses and factors that influence the difficulty children may have in returning to their pre-disaster state. Yule and Canterbury (1994) reviewed a number of studies concerning children exposed to traumatic events. The types of reactions experienced by many children reported include feeling irritable, alone, and having difficulty talking to their parents. Many experience guilt for not being injured or losing their homes. Adolescents are prone to bouts of depression and anxiety, while younger children demonstrate regressive behaviors associated with earlier developmental stages. Many children who have difficulty reconciling their feelings will engage in play involving disaster themes and repetitive drawings of disaster events. It has also been demonstrated that children as young as two or three can recall events associated with disasters. The child's level of cognitive development will influence their interpretation of the stressful events. Some studies reviewed by Yule and Canterbury suggest that the intellectual ability of the child, their sex, age, and family factors influence their recovery. Girls experience greater stress reactions than boys, bright children recover their pre-disaster functioning in school more rapidly, and families who have difficulty sharing their feelings experience greater distress. As expected, there also appears to be a direct relationship between the degree of exposure to frightening events and the difficulty in emotional adjustment and returning to pre-disaster functioning.
Other researchers have attempted to explain what factors influence children's reactions to traumatic or stressful events. In their review of the emotional effects of disaster, Lewis Aptekar and Judith Boore (1990) report that one's belief as to who or what caused the disaster and the degree of destruction are major factors influencing children's reactions. These authors have also identified five additional factors that influence recovery from the traumatic event:
child's developmental level
child's premorbid mental health
community's ability to offer support
parents' presence or absence during the event
significant adults' reaction
A more recent review by Vogel and Vernberg (1993) also suggests the influence of children's developmental level on their ability to comprehend traumatic events, their coping repertoire, and their involvement with other groups of people beyond the immediate family.
In a longitudinal study, Vernberg, LaGreca, Silverman, and Prinstein (1996) provided a thoughtful account of how elementary school children responded to the disastrous impact of Hurricane Andrew in Dade County, Florida. These researchers concluded that many symptoms experienced by these children could be understood using an integrated conceptual model first discussed by Green et al. (1991). Green et al. investigated four factors:
exposure to traumatic events during and after the disaster
pre-existing child characteristics
post-disaster recovery environment (social support)
coping skills of the child
The model suggested by Vernberg, et al. (1996) increased the number of factors from four to five:
exposure to traumatic events during and after the disaster
pre-existing demographic characteristics
occurrence of major life stressors
availability of social support
type of coping strategies used to manage disaster-related stress
The primary focus of this study was to ascertain what factors influence the lingering symptoms and subsequent identification of children experiencing PTSD. The authors conclude that symptoms associated with PTSD could represent normal adaptive reactions and that for many children the effects of a disaster may still be observed beyond one to two years after the event. In trying to determine what made the various symptoms persist in these elementary age children, the researchers found the daily hassles of routine life in the weeks and months following the incident interacted with the severity of the trauma experienced making it difficult to recover. The strains of ongoing life events (e.g., loss of employment by a parent, divorce, or other stressors) also impact the availability of a supportive environment. Other factors identified by the authors were the overall loss of essential support from the community and schools given the respective impact of the disaster on these social systems.
TYPICAL REACTIONS OF CHILDREN
Fears and anxieties
Fear is a normal reaction to disaster, frequently expressed through continuing anxieties about recurrence of the disaster, injury, death, separation, and loss. Because children's fears and anxieties after a disaster often seem strange and unconnected to anything specific in their lives, the child's relationship to the disaster may be difficult to determine. In dealing with children's fears and anxieties, accepting them as very real to the children is generally best. For example, children's fears of returning to the room or school they were in when the disaster struck should be accepted at face value, and interventions should begin with talking about those experiences and reactions.
Before the family can help, however, they must understand the children's needs; this also requires an understanding of the needs of the family. As discussed throughout this manual, families have their own unique pre-disaster profile of beliefs, values, fears, and anxieties. Frequently, dysfunction in the family is mirrored in the child's malfunctioning. The disaster mental health worker may need to talk with the family as a whole to better understand the role the whole family can play in responding to its own set of fears and anxieties that may exacerbate the fears expressed by the children. Sometimes, the pre-disaster level of dysfunction in the family may be so severe that referral for more formal mental health services may be necessary.
A parent's or adult's reaction to children makes a great difference in the children's recovery. The intensity and duration of children's symptoms decrease more rapidly when families can show that they understand their feelings. When children believe their parents do not understand their fears, they feel ashamed, rejected, and unloved. Tolerance of temporary regressive behavior allows children to redevelop those coping patterns that had been functioning before the disaster. Praise offered for positive behavior produces positive change. Routine rules need to be relaxed to allow time for regressive behaviors to run their course and the reintegration process to take place.
When children show excessive clinging and unwillingness to let their parents out of their sight, they are expressing their fears and anxieties of separation or loss. They have experienced the harmful effects of being separated from their parents and in their clinging are trying to prevent a possible recurrence. Generally, the children's fears dissolve when the threat of danger has dissipated and they feel secure again under the parent's protection.
Children are typically most fearful when they do not understand what is happening around them. Every effort should be made to keep them accurately informed, thereby alleviating their anxieties. Adults frequently fail to realize the capacity of children to absorb factual information and do not share what they know. Consequently, children receive only partial or erroneous information.
Most important to resolving disaster related fears and anxieties in children is the quality of safety and security present in the family. The family should make every effort to remain together as much as possible, for a disaster is a time when the children need their caregivers around them. In addition, the model adults present at this time can be growth enhancing. For example, when parents act with strength and calmness, while maintaining control and sharing feelings of being afraid, they serve the purpose of letting the children see that acting courageously even in times of stress and fear is possible.
Sleep Disturbances
Sleep disturbances are among the most common problems for children after a disaster. Behaviors associated with sleep disturbances are likely to take the form of resistance to bedtime, wakefulness, unwillingness to sleep in their own rooms or beds, and refusal to sleep by themselves. Children will also express a desire to be in a parent's bed or to sleep with a light on, insist that the parent stay in the room until they fall asleep, or may begin to rise at excessively early hours. Such behaviors are disruptive to a child's well-being. They also increase stress for parents, who may themselves be experiencing some adult counterpart of their child's disturbed sleep behavior. More persistent bedtime problems such as sleep terrors, nightmares, continued wakening at night, and refusal to fall asleep may point to deep-seated fears and anxieties that may require professional intervention.
In working with families, exploring the family's sleep arrangements may be helpful. Long-term adjustments in sleeping arrangements, such as allowing children to sleep routinely in the parent's bed, will inhibit the child's recovery process. However, temporary changes following a disaster may be in order. For very young children, it may be especially reassuring to have close contact with their parents during those times when disaster fears are most prominent. After a brief period of temporary changes, the parents should move toward the reinstatement of pre-disaster bedtime routines. Thus, the family may need to develop either new or familiar bedtime routines, such as reinstating a specific time for going to bed. The family may find it helpful to plan calming, pre-bedtime activities to reduce chaos in the evening. Teenagers may need special consideration for bedtime privacy. Developing a quiet recreation in which the whole family participates is also helpful.
Besides the above descriptions of fears, anxieties, and sleep disturbances, children's reactions to a disaster can be expressed in many different forms. Below are some more common reactions. (For convenience, the reactions are presented for three age groups: preschool or early childhood, latency age, and pre-adolescence and adolescence.)
Preschool, Five Years Old and Younger
Most of the symptoms appearing in this young age group are nonverbal fears and anxieties expressed as the result of the disruption of the child's secure world. These symptoms include:
crying in various forms, with whimpering, screaming, and explicit cries for help
becoming immobile, with trembling and frightened expressions
running either toward the adult or in aimless motion
excessive clinging
Regressive behavior, that is, behavior considered acceptable at an earlier age and that the parent had regarded as past may reappear. This includes the following:
thumb sucking
bed-wetting
loss of bowel/bladder control
fear of darkness or animals
fear of being left alone or of crowds or strangers
inability to dress or eat without assistance
Symptoms indicative of fears and anxieties include:
sleep terrors (i.e., child abruptly sits up in bed screaming or crying with a frightened expression and autonomic signs of intense anxiety. The child is unresponsive to the efforts of others to awaken or comfort him/her. If awakened, the child is confused and disoriented for several minutes and recounts a vague sense of terror usually without dream content.)
nightmares (i.e., frightening or anxiety producing dreams)
inability to sleep without a light on or someone else present
inability to sleep through the night
marked sensitivity to loud noises
weather fears - lightning, rain, high winds
irritability
confusion
sadness, especially over loss of persons or prized possessions
speech difficulties
eating problems
The symptoms listed above may appear immediately after the disaster or after the passage of days or weeks. Most often they are transient and soon disappear. Parents can help diminish the above symptoms in their children through understanding the basis for the behaviors and giving extra attention and caring. If the symptoms persist for longer than a month, parents should recognize that a more serious emotional problem has developed and seek professional mental health counseling.
Latency Age, Six Years Old Through 11 Years Old
Fears and anxieties continue to predominate in the reactions of children in this age group.
However, the fears demonstrate an increasing awareness of real danger to self and to the children's significant persons, such as family and loved ones. The reactions also begin to include the fear of damage to their environment. Imaginary fears that seem unrelated to the disaster also may appear.
Regressive behaviors may appear in this age group similar to those in the preschool group. Problem behaviors include the following:
bed-wetting
sleep terrors
nightmares
sleep problems (e.g., interrupted sleep, need for night light, or falling asleep)
weather fears
irrational fears (e.g., safety of buildings, or fear of lights in the sky)
Additional behavior and emotional problems include:
irritability
disobedience
depression
excessive clinging
headaches
nausea
visual or hearing problems
The loss of prized possessions, especially pets, is very difficult for children in this age group. As noted in the previous section, the school environment and relationships with peers is central to the life of latency age children. School problems begin to appear and may take the form of:
refusal to go to school
behavior problems in school
poor school performance
fighting
withdrawal of interest
inability to concentrate
distractability
peer problems (e.g., withdrawal from play groups, friends, and previous activities or aggressive behaviors and frequent fighting with friends or siblings)
Preadolescence and Adolescence, 12 Years Old Through 17 Years Old
Adolescents have great need to appear competent to the world around them, especially to their family and friends. Individuals in this age group are struggling to achieve independence from the family and are torn between the desire for increasing responsibility and the ambivalent wish to maintain the more dependent role of childhood. Frequently, struggles occur with the family, because the peer group seems to have become more important than the parental world to the adolescent child. In the normal course of events, this struggle between adolescents and family plays itself out and depending on the basic relationships between the child and his or her parents, they resolve the trials and problems.
The effects of a major disaster on adolescents will vary depending on the extent to which it disrupts the functioning of the family and the community. The impact of the disaster may stimulate fears related to loss of family, peer relationships, school life, and even concern over the intactness of their own bodies. Adolescents struggling to achieve their own identity and independence from the family may be set back in this personal quest with reactivated fears and anxieties from earlier stages of development. The trouble signs to watch for in pre-adolescents and adolescents include:
withdrawal and isolation
physical complaints (e.g., headaches or stomach pain)
depression and sadness
antisocial behavior (e.g., stealing, aggressive behavior, or acting out)
school problems (e.g., disruptive behavior or avoidance)
decline in academic performance
sleep disturbances (e.g., withdrawal into heavy sleep, sleep terrors, or sleeplessness)
confusion
risk taking behavior
alcohol and other drug use
avoidance of developmentally appropriate separations (e.g., going to camp or college)
Most of the above behaviors are transitory and disappear within a short period. When these behaviors persist, they are readily apparent to the family and to teachers who should respond quickly. Teenagers, who appear to be withdrawn and isolate themselves from family and friends, are experiencing emotional difficulties. They may be concealing fears they are afraid to express. Just as many adults do, adolescents often show their emotional distress through physical complaints.
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