EFFECTS OF VIOLENCE & DISASTERS
ON CHILDREN
"Interventions shortly after a trauma help the child."
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The September 11 tragedy has caused people to ask about the impact of disasters and
community violence on children. Such occurrences unfortunately are not rare experiences in
the lives of children. Disasters are classified as natural (earthquakes, floods, tornados)
or human-caused (fires, terrorist attacks, auto accidents) events. Some children are also
exposed to violence such as gang violence or drive by shootings. Although the details of
each disaster or violent act are different, the potentially adverse psychological effects
and developmental implications are similar. Children are impacted differently than adults
due primarily to their developmental differences. Reactions among children differ depending
on their age. Developmental differences have implications for designing disaster response
interventions and for general recovery. Interventions shortly after a trauma help the child.
Children's psychological and social development are dynamic from infancy to early
adulthood. Psychological development includes cognitive abilities and emotional states.
Social development entails a changing pattern of relationships with parents and other
caretakers, family, and peers.
MEDIATING FACTORS
Key factors influencing psychological reactions of children to disasters include:
- the type of disaster (human-caused generally have a more adverse impact than natural
ones);
- prior state of child's emotional well-being;
- prior traumatic exposures
- the child's physical injuries caused by the event(s);
- impact on caretakers and siblings;
- reactions of caretakers;
- secondary adverse effects such as prolonged disruption of the routine of the child and
family
- gender (females are at greater risk of severe reactions); and
- extent of losses suffered by the individual child and family.
The level of disruption to other key community structures such as school may also
influence the reaction. A high frequency of media exposure, especially television, to the
disaster may intensify the child's reaction.
TYPICAL REACTIONS OF CHILDREN
Most children experience varying degrees of stress throughout their development. Most will
recover readily from mild to moderate stress by their own coping methods and/or with
emotional support provided by parents and friends. Similarly, many children recover from
severe stress (commonly referred to as psychological trauma), albeit over a longer duration,
but psychological trauma can overwhelm some children's internal capacity to cope.
Children exposed to disasters and community violence often exhibit a wide range of
reactions which generally begin immediately after exposure or, less commonly, days or weeks
later. Many such reactions are a normal response to the events. Fears, anxiety, sleep
disturbances, and preoccupation with aspects of the disaster or act of violence are probably
the most frequent reactions. Parents of such children will often effectively intervene by
listening to their children, acknowledging the child's disaster related fears, and
temporarily tolerating changes in behavior such as sleeping with parents and excessive
clinging. Brain research indicates that fundamental brain mechanisms relevant to coping,
behavior, learning, and memory can be effected in severe reactions.
Most reactions are generally more intense during the first few days after the event(s),
then begin to dissipate after several weeks; some children may continue to exhibit symptoms
for several months if not years. Many of the frequent reactions or symptoms caused by
exposure to disasters can be classified by age groups, although there can be considerable
overlap in reactions across age groups.
At ages 0 to 5, crying, screaming, inability to move, trembling and aimless running can
occur. Many very young children will engage in regressive behavior (behaviors that were
normal at an earlier stage of development). Such behaviors might include thumb sucking,
bed-wetting, loss of bladder and even bowel control, inability to dress or feed selves,
being disturbed by sudden changes in weather, or specific fears, such as fears of strangers.
At ages 6 to 11, a child has a different level of awareness of threats to personal and
family safety. Regressive behaviors are not uncommon. Some of these children will exhibit
disobedience, if not outright defiance, depression, headaches, stomach aches, nausea, and
even visual or hearing problems, deterioration in academic performance, and school refusal.
A loss of interest in commonly enjoyed activities may occur.
Children ages 12 to 17 have embarked on a new level of development in which they are
struggling to become more self-reliant, to establish an identity distinct from that of their
family, and to develop much closer relationships with their peers. Social withdrawal or
isolation, depression, school problems and physical complaints are common. They may also
initiate a pattern of risk taking behaviors that include alcohol and other drug use,
indiscriminate sexual behavior, other anti-social behaviors, and increased dependence on
family.
SEVERE REACTIONS
Many children may develop Acute Traumatic Stress Disorder and/or Posttraumatic Stress
Disorder among other severe syndromes. Some characteristics of these syndromes are:
- nightmares or flashbacks (reliving the experience involuntarily);
- distress over events that resemble the original event;
- repeated play that resembles aspects of the event(s);
- behaviors which enable the child to avoid reminders of the event;
- diminished interest in environment and social circle;
- a sense of a foreshortened future;
- sleeping problems, poor concentration, and
- startle reactions.
HELPING CHILDREN RECOVER
Clinical consensus strongly suggests that a combination of interventions shortly after the
trauma helps the child. Typical settings are an office or classroom. No single intervention
will enable a child to completely recover. The selection of interventions depends on several
factors, especially the initial reaction and the pace with which the child has resumed his
or her normal daily functioning.
Early intervention includes protecting children from further harm and exposure to the
stressful events and providing them with supportive and compassionate verbal exchanges.
Parents particularly appreciate it when caretaking adults and teachers explain normal
reactions to such events Some of the most helpful and reassuring interventions are:
- providing factual information (in order to curtail rumors) to children in a language
they can understand;
- eliciting thoughts and feelings about events in a structured fashion though play/art
activities;
- allaying self-blame and acknowledging normal reactions;
- engaging children in activities such as letter writing to victims and their families
(often allays the commonly-found sense of helplessness);
- teaching children skills to help them avoid becoming victims; and
- identification of children with acute severe reactions, to provide them more intensive
assistance.
Ongoing professional care involving specialized forms of psychotherapy such as cognitive
behavioral therapy (CBT), trauma/grief-focused psychotherapy, and family therapy or
consultation for children who develop more severe reactions may be warranted. Medication may
be indicated, primarily in teenagers, to reduce sleep disturbances, depression, startle
reactions, intrusive thoughts, and some avoidance behaviors. Utilizing mental health
professionals with expertise and/or training in the treatment children is essential.
It is also imperative to determine the degree of impairment caused to the caretaking
adults by the events, since they must be capable of assisting the professional and the child
in the child's recovery. Guidance for parents regarding media exposure to the events is also
important, to avoid further adverse psychological impact. Enhanced safety at school and in
the neighborhood, as perceived by the child, may also expedite the child's recovery.
Useful resources on this subject: American
Psychiatric Association, American
Academy of Child and Adolescent Psychiatry, National
Institute of Mental Health, American
Academy of Pediatrics, Center for
Mental Health Services, Emergency Services and Disaster Relief Branch, Office
for Victims of Crime Resource Center Federal Emergency Management Agency (info for
children and adolescents and teachers).
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