People respond in a wide variety of ways in the face of natural disasters, major acts of violence or public health emergencies. Children and adolescents tend to experience and exhibit trauma differently from adults. Developing an awareness of common reactions to trauma is the first step to providing “psychological first aid”. Sometimes normal responses progress into prolonged and problematic symptoms and behaviors. Recognizing when this shift occurs can assist caregivers in seeking out appropriate professional help. Equipped with the right information and access to resources, people are able to not only recover from trauma, but also develop increased resilience.
BEFORE THE DISASTER
Depending on the nature of the disaster, families and communities may be able to implement preparatory strategies. Caregivers can help their children and adolescents by:
- Talking about the potential disaster and the damage a disaster might create
- Deciding which number to call and on a place to meet in case of a disaster
- Putting supplies together for an emergency preparedness kit
- Safeguarding personal possessions and storing them where they are protected
- Emphasize the preparations and safety plans rather than the potential disaster to increase likelihood of reassurance and reduce the likelihood of simply increasing anxiety and worry.
DURING AND AFTER THE DISASTER
To provide appropriate support during and after a disaster has struck, it is essential to know the physical, emotional and psychological ways that children and adolescents respond to stress based on their developmental level.
Pre-School Age Children
- Bed wetting, loss of age appropriate verbal skills and motor function, and/or other regressive symptoms may intensify in some younger children, or reappear in children who had previously outgrown them
- Complaining of stomach cramps or headaches
- Crying and clinging to caregivers or fear of being separated from caregivers
- Startle response to sudden and loud noises, sudden immobility of the body, heightened arousal, cognitive confusion, and sleep problems
- Repeated play or re-enacting of the disaster/trauma event
Grade-School Age Children
- Preoccupation with the details of the disaster and with safety and danger
- Desire to continually talk about the event
- Fear that the disaster will occur again
- Closely observing caregiver(s) anxiety
- Sleep problems, loss of interest in usual activities
- Anger and aggression
- Trying to down-play their worries
- Concentration problems, school performance and attendance problems
- Depression, sleep problems, thoughts or plans of suicide/suicide pacts.
- Behavior that includes life-threatening re-enactment of the trauma/disaster.
- Engaging in self destructive behavior (e.g., sexual risk taking, substance abuse)
- Action oriented/wanting revenge
- Self focused behavior (e.g., inability to think about others)
- Have shortened sense of the future and changes in plans for the future(e.g., not going to college)
What to Do and How to Help
Caregivers may find implementing the following strategies helpful during and after the disaster:
Tips for Structuring the Environment
- Create an environment that is safe and provide reassurance
- Limit TV time- where the disaster/trauma event is reported on, monitor children’s media exposure to the event and information they receive on the internet
- Create routines (for work, play, meals, and rest); this increases feelings of predictability and stability which can be shaken by a disaster.
- If possible, maintain the same pre-disaster routines
- Involve children/adolescents by giving them chores to make them feel that they are helping to restore their family and community; increasing feelings of usefulness, helpfulness to others, and having some control/effect on the environment are very helpful
- Spend extra time with children at bed time, consider staying until the child falls asleep in order to make him or her feel protected
- Work with the school,. Since short term memory and concentration might be impacted by a disaster, test taking, studying, and completion of assignments may be more challenging
- Encourage participation in developing/revising a family disaster plan
Tips for Communicating
- Answer all questions and provide loving comfort and care
- Provide age-appropriate information about the disaster event calmly and factually
- Provide opportunities to talk about the disaster, but do not pressure the child/adolescent
- False reassurance is not helpful. Don’t say “tragedies will never affect your family again;” children will know this isn’t true. Instead, say “You’re safe now and I’ll always try to protect you” or “Adults are working very hard to make things safe.” Remind children that tragedies are very rare.
Tips for Addressing Emotions and Behaviors
- Get a better understanding of a child’s feelings about the disaster: engage in gentle, reflective, and “normalizing”, not pushy or intrusive, questions and statements, e.g., “this was pretty scary” or “you look angry” or “people often worry when something like this happens”.
- Discuss the disaster with them and find out each child’s particular fears and concerns (see the suggestion above)
- Encourage children to express their feelings through talking, drawing or playing; allowing them to do so, and then talking about it, gives you the chance to "re-tell" the ending of the game or the story they have expressed in pictures with an emphasis on personal safety
- You can work to structure children’s play so that it remains constructive, serving as an outlet for them to express fear or anger
- Be understanding of the child/adolescent’s need to mourn his/her own loss
- Do not punish the child for regressive behavior (know that this is only temporary)
- Praise and recognize responsible and age-appropriate behavior
WHEN TO CONSIDER SEEKING PROFESSIONAL HELP
Some symptoms may require immediate attention. Contact a behavioral health professional if these symptoms occur:
- Racing heart and sweating
- Being easily startled
- Being emotionally numb
- Being very sad or depressed
- Suicidal thoughts, plans, or behavior
- Refusing to go places that remind them of the event
- Seems numb emotionally
- Shows little reaction to the event
- Behaves dangerously, threatening to harm self or others
- Unable to perform normal routines
RESOURCES AND REFERENCES
- American Counseling Association’s Traumatology Interest Network
- Center for Disease Control and Prevention
- American Red Cross and FEMA-Helping Children Cope with Disaster
- National Mental Health Association-Mental Health America
- National Institute of Mental Health
Lorna Tempest is a Licensed Professional Counselor and a Licensed Marriage and Family Therapist working at Colonial Behavioral Health’s Outpatient Child and Adolescent Program. She completed her graduate studies at the College of William and Mary and has been with CBH since 2005. Lorna has received specialized training in trauma-related issues. She was also a Disaster Mental Health Volunteer for the American Red Cross, aiding in the recovery of Hurricane Katrina in the New Orleans area.