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Posted by on May 21, 2013 in Health, Mental Health, Outreach, Psychology | 4 comments

Normal and Unexpected Behaviors after a Disaster

supercell

Supercell right before dropping a tornado on May 19, 2013 outside of Prague, OK

 

Earlier today, Moore and south Oklahoma City were hit with an absolutely devastating tornado that appears as if it will eclipse the infamous May 3rd, 1999 storms as the worst to ever hit Oklahoma. This comes less than 24 hours after other tornadoes ripped through multiple towns in Oklahoma. While tornadoes are not exactly rare in Oklahoma (we have more per square mile than anywhere else on earth), today’s biggest one destroyed multiple schools and carved it’s way right through a major city.

As a life-long Oklahoman, I am still completely shocked at the power and devastation that a tornado can cause every time one happens (and there were at least 15-20 distinct tornadoes in the past two days here in the state). As a psychologist, I’ve dedicated a significant amount of time and effort to research on how children adapt and cope with very frequent natural disasters, as well as writing and giving talks on the subject. Below is some information on what you, as a parent, teacher, or someone else in contact with children, can do to support your child at this time.

Barriers to Effective Interventions

A key issue in working with children is understanding those responses in children that are normal versus those that require intervention.  There are several barriers to effective identification of children who need intervention following a disaster (for evidence-based ways to assess for trauma, please see this chapter of mine). What we want to do overall, though, is help children move from being victims to being survivors. Victims are those who feel they have no control over their current situation.  Survivors are those who have regained a sense of control and are able to meet the demands of whatever difficulty confronts them.  Victims are passive and dependent on others, while survivors are active and involved

The first barrier is that children who have experienced disasters do so triply:

  • Even very young children are directly affected by experiences of death, destruction, terror, personal physical assault, and by experiencing the absence or powerlessness of their parents.
  • Children are also powerfully affected by the reactions of their parents and other trusted adults (such as teachers) to the disaster. They look to adults for clues as to how to act. If their parents and teachers react with fear, the child’s fear is magnified. If they see their elders overcome with a sense of loss, they feel their own losses more strongly.
  • Children’s fears may also stem from their imagination. Children have less ability than adults to judge which fears are realistic and which are not. Regardless of the source, a child’s responses to a disaster should be taken seriously. A child who feels afraid, regardless of the reason, is afraid.

Other barriers include that teachers and parents may misinterpret problematic behavior as just being willful, rather than being indicative of clinical-level concerns. This may be in part due to some  adults not wishing to be reminded of their own reactions, and they thus ignore or minimize a child’s reaction. It can also be due to the fact that most children (80% or so, depending on the type of disaster),  respond appropriately to a disaster, which leads some to think that all the children are doing fine.

A final potential barrier is that a strong response to a disaster or trauma is normal and expected. Indeed,  up to 90% of children show psychological reactions immediately after a disaster, while 20-50% show strong reactions up to a year later. Despite this,  the majority of these children will not need services other than care and support from family, friends, and school

How Children React to Trauma

There are three phases of a child’s reaction to a disaster:  during the disaster; immediately following the disaster; and long-term reactions to the disaster. Certain types of reactions are normal during each phase, and education about them can help you know if a child is doing well or not.

During the Disaster

When confronted with a trauma, children have the “fight or flight” response:

  • Muscles tense, heart pounds
  • Nerves are on high alert
  • Intense anxiety or fear
  • Shock, sense of unreality, not understanding what is happening

This is normal and expected, and is typical to see in the immediate aftermath and even up to several days later (especially when presented with reminders of the disaster).

Immediately Following

  • In the weeks after a trauma, up to 90% of children may experience
  •  Heightened physiological arousal
  • Diffuse anxiety
  • Survivor guilt
  • Emotional lability

Again, these are all normal reactions and should be met with understanding and support, not by seeking counseling or therapy.

Long-Term

By 1-2 years post-disaster, the majority of children (80% or more) will show few problematic symptoms.  A time to watch out for, however, is the anniversary of the disaster, when there may be a large number of potential triggers that remind someone of the trauma.

What is important to watch out for is those children still displaying the following difficulties 3-4 months after the disaster, as they may need further assessment and potential intervention. The symptoms vary somewhat by age, as broken down below.

In children below age 6, these may indicate problematic adjustment to the disaster:

  •  Generalized anxiety about separation, strangers, or sleep problems
  • Avoidance of certain situations
  • Preoccupation with certain symbols / words
  • Limited emotional expression or play activities
  • Loss of previously acquired skills

For older children, warning signs of problematic adjustment are:

  •  Repetitious play reenacting a part of the disaster
  • Preoccupation with danger or expressed concerns about safety
  • Sleep disturbances and irritability
  • Anger outbursts or aggressiveness
  • Excessive worry about family or friends
  • Symptoms of Concern
  • School avoidance, particularly involving somatic complaints
  • Behaviors characteristic of younger children
  • Changes in personality, withdrawal, and loss of interest in activities

One or more of these may be indicative of a maladaptive response to the disaster – of being a victim rather than a survivor. In that case, a referral to a mental health specialist who is familiar with trauma and children’s reactions could be needed.

Vulnerable Populations

Certain children are at greater risk for responding poorly after a trauma. In particular, those whose experience was especially terrifying or extreme,  children between 5-10 years of age (especially if separated from parents during or after), and  those with a prior history of any type of traumatic experience need to be monitored carefully. It is also important to provide  strong social support networks to all children, as this can help to mitigate negative responses.

What Parents & Teachers Can Do

Talk with the child about his or her feelings, without passing judgment. Allow them to cry or be sad. Don’t expect him or her to “be tough.” Talk about your own feelings, as well. Encourage the child to draw pictures about the disaster or write stories or poems about the disaster. This will help you understand how he or she views what happened, which is an important predictor of their adjustment in the future.

Provide the child with factual information about what happened and what is going to (or will) happen. Use simple, direct language they can understand. Shielding a child from unpleasant information usually leads to more difficulty in the future. Correct any misunderstandings a child may have (such as that the disaster was, in some way, his or her fault). This, though, does not mean that they should be exposed to constant reminders or the disaster (such as ongoing news coverage).

Children are especially vulnerable to feeling abandoned when they are separated from their normal routine. A return to school or a structured environment is often beneficial to children. Teachers and others who notice a student who is missing large amounts of school or planned activities after a disaster, should contact parents and encourage them to have the child return as soon as possible.

But, most of all, these children need your support. They need to know that they are supported and loved by their family, friends, and communities. Not just in the immediate aftermath, but in the weeks, months, and sometimes years that follow.