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Resources for Trauma Children
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Children's Reaction to Disaster Children depend on us for care and protection. When these needs are not fulfilled, they can become distressed. When the threat to their physical and psychological being is out of the ordinary, their distress can become extreme. Children's reactions to a major disaster may fall into four categories:
  1. They may try to understand and resolve the experience by becoming over- involved with it.
  2. They may become overwhelmed by it and become detached from what is going on around them.
  3. They may react with extreme fear, extreme wariness or with avoidance.
  4. They may regress to a less mature behavior.
Thus, children can react to threats in ways that seem unusual or too intense. Regardless of the intensity of the child's response to a major disaster, remember that it is an unusual response to an unusual situation, and it is likely to resolve over time. We as adults can support our children by knowing what to expect and how to help them. Children's specific responses to extreme threats The types of behavior we might see in a child after a major disaster could be in the physiological, cognitive, emotional, or interpersonal areas. Physiological functioning Lack of appetite, difficulties in falling asleep, cramps and body pains, bedwetting, fatigue, drinking and substance abuse (in adolescence). Imagining catastrophes Imagining various kinds of unlikely dangers and risks, especially concerning parents and relatives. Children very often report nightmares. Emotional functioning Helplessness, hopelessness, sadness, anger, fears - general or specific, especially fears about separation from parents and being alone. Cognitive functioning - thought processes Difficulties in concentration, focusing and doing school work. Misconceptions about what is going on. Asking the same questions again and again. Cognitive functioning - the content of the child's thoughts Self-blaming ("I have not done enough", "Why not me?" "It is my fault"); Shame ("Why am I so helpless?" "I'm weak"); Concerns about what may happen to parents; Questions about death and afterlife. Interpersonal functioning Isolation, dependency, quarrelsomeness, aggressive sexual behaviors (in adolescence). What can a parent or a teacher do? Some general guidelines:
  • The first thing that you as an adult can do to help your child overcome the impact of a major disaster, is to keep yourself calm, take care of your own well-being, and try to reduce your fears. Naturally, you may feel some distress yourself, and taking care of your own distress as well as that of your children may seem difficult. At the same time, parents draw extra courage from the need to protect their children.
  • Try to return to, and maintain the normal routines, as soon, and as much as possible.
  • Give your child a lot of support, both physical and emotional.
  • Give your child opportunities to express negative emotions such as fear and anger.
  • Be available for answering questions and giving explanations according to the child's level of understanding.
Here are some specific actions that parents can take to help a distressed child after a disaster: Physiological Encourage the child to sleep and eat as much as he or she needs. Don't force the child to eat if he or she can't, or refuses. Encourage your child to perform various activities such as helping others or physical (athletic) activities. Taking care of a pet is very productive. Train the child in relaxation or slow deep breathing. Do not give your child any medication unless prescribed by a physician. Cognitive Give the child information appropriate to his or her age. The information should be simple, reliable, based on what they can comprehend, and in tolerable dosage. Studies have demonstrated that children can face a difficult reality as long as they receive support and appropriate care. It is important to refute incorrect rumors and to correct misconceptions. If you don't know an answer to a specific question, say so, and promise to get an answer if relevant. Encourage coping and problem solving - past and present. Avoid lies and over-dramatic descriptions of the disaster. Emotional Acknowledge emotional expressions such as fears and anxiety, anger and rage. You may be a role model in expressing emotions when appropriate. Stories, drawing, role-playing, creative writing, and all kinds of activities that enable expressiveness are all helpful. Use humor when possible. Behavioral Try to maintain and return to daily routines as soon as possible. Do fun and recreational activities such as walking, hiking, riding bikes, going to movies, and listening to music. Give simple instructions on what to do in specific dangerous situations, such as:

"If you see an envelope with white powder around it, don't touch it! Cover it with whatever you have, walk away from it, wash your hands with soap and water, and tell an adult what you saw."

Interpersonal Encourage your child to help friends; helping others helps the helper as well. Use social support systems such as close friends and relatives. Encourage your child to engage in social interactions. When you interact with your child use empathic listening, and avoid criticism and labeling the child's behavior in negative terms. Remember! The child's behavior in these situations is an unusual but expected response to an unusual situation. The impact of the disaster on the child depends on:
  • The way he or she perceives the situation.
  • The response of the adults around him (parents, teacher) to the situation.
  • The degree to which his daily routine has been disrupted.
  • The amount of exposure and proximity to the incident, either physical of psychological (a child of a rescue worker or a relative of a victim may react in a more intense manner than other children).
Remember! Children are very resilient. Most children, like adults, return to their normal activities and resolve their fears fairly soon. When to consider professional help
  • When there is no decrease in the intensity and frequency of the responses to the incident within a month.
  • When the child's responses become more severe.
  • When there is a serious disruption in the child's daily activities such as school refusal and difficulties in activities at school.
When searching for appropriate professional help it is advisable to consider a mental health worker who is familiar with cognitive behavioral approaches. Research findings tell us that cognitive therapy is extremely effective with these problems. To find a qualified psychotherapist in this approach, click here. Be sure to ask the therapist if he or she specializes in work with children. Below are sites for the National Association of School Psychologists. These pages include valuable information on responses to disaster and recovering from grief. http://www.nasponline.org/resources/crisis_safety/neat_poland.aspx http://www.nasponline.org/resources/crisis_safety/index.aspx/
Helping Children Cope with Trauma As a resource for helping children cope with this week's tragedy, I wanted to share with you several tools prepared by the American Academy of Child and Adolescent Psychiatry (AACAP). Attached you will find links for the AACAP's Talking Points - How To Talk To Children and Parents After A Disaster. They're "light" in that they are somewhat short on specific recommendations for intervention, but are appropriate for sharing with parents. The two Facts For Families can be downloaded at: http://www.aacap.org/publications/factsfam/grief.htm Facts for Families # 8 - Children and Grief http://www.aacap.org/publications/factsfam/disaster.htm Facts For Families #36 - Helping Children After A Disaster. The "Facts for Families" are designed to be reproduced and distributed. Please feel free to make these available to your patients and their families, schools, and any other organizations which may benefit from the information. If you need additional information about these you can contact Rod Clark at AACAP. His email address is: rclark@aacap.org or by calling 202-966-7300 ext.120.