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Children and Disasters - Part II
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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