After the storm, children play out fears

By Scott Sleek
Monitor staff

Not long after the 1995 Oklahoma City bombing, preschoolers who survived the blast would play 'hospital,' using toy figures with missing limbs.

Children who survived Hurricane Hugo in 1989 made pretend trees out of broccoli at the supper table, then poured gravy all over the 'trees' to mimic rushing waters ravaging the landscape.

These forms of post-traumatic play illustrate the ongoing and often unrecognized emotional struggles children experience after witnessing massive death and destruction, psychologists say.

Children were once thought to be largely immune from the type of nightmares and despair that adults experience after suffering psychological trauma. But in the past 10 years, psychologist have found that children can suffer from post-traumatic stress disorder (PTSD), and it often comes out in the way they play.

However, their needs are often unmet, psychologists say. 'In Oklahoma City, we found a high percentage of children showing some signs of distress,' says Robin Gurwitch, PhD, a University of Oklahoma Health Services Center psychologist who conducted research on the bombing?s effects on children. 'But when we asked them if they had talked to someone?a counselor or a teacher, for example?the overwhelming response was ?No.?'

Psychologists are trying to better understand the impact disasters have on children and to help emergency medical response teams incorporate psychological care into the services they provide to young disaster victims. Their goal is to improve an inadequate mental health response to children who survive floods, hurricanes, bombings and other disasters.

APA?s Public Interest Directorate, for example, provided consultation services in 1996 and 1997 to the Emergency Medical Services for Children (EMSC) program of the federal Maternal Child and Health Bureau. The directorate suggested, for example, that federal disaster relief agencies incorporate pediatric psychology information into its guidelines for disaster relief services. Directorate staff hope to continue working with EMSC on developing better services for children in emergency situations.

APA?s Practice Directorate has also sought to improve services for children who have experienced trauma. It has produced a brochure for the general public, 'Managing Traumatic Stress: Tips for Recovering From Disasters and Other Traumatic Events,' which includes information on steps parents can take to alleviate the emotional consequences their children may experience after a disaster.

Children are often reluctant to talk about their own feelings following a disaster, particularly because they?re well aware of the emotional struggles their parents and other adults are going through.

Members of APA?s Disaster Response Network often use the brochure when they provide on-site services after a disaster.

And in February, EMSC sponsored a conference in Orlando, Fla., on children?s emergency needs in disasters. The event included presentations from a variety of psychologists and other mental health experts on the psychological needs of child disaster victims.

Symptoms

With a spate of natural and manmade disasters occurring over the last 10 years, psychologists have been able to discover enlightening details about the ways that young minds deal with catastrophes. In her research of Oklahoma City preschoolers, Gurwitch found that children who survived the terrorist bombing of the Alfred P. Murrah Federal Building were manifesting sleep disturbances, aggressive behavior and increased clinging to their parents.

Landmark research on 550 children who survived Hurricane Andrew in 1992 was conducted by Annette LaGreca, PhD, a University of Miami psychologist, along with colleagues Wendy Silverman, PhD, (Florida International University), Eric Vernberg, PhD (University of Kansas), Mitchell Prinstein, PhD (Brown University School of Medicine) and Nicole Vincent, PhD (University of Washington, Seattle Children?s Hospital).

The group found that about 30 percent of the Florida children demonstrated moderate to severe levels of PTSD one year after the hurricane. When a subgroup of the most affected children were followed nearly four years after the hurricane, it appeared 40 percent of them continued to report moderate to severe PTSD symptoms. Based on her study, LaGreca, chair of APA?s Public Interest Directorate Committee on Children, Youth and Families, found several factors that increase a child?s risk of long-term emotional problems following a disaster.

For example, children who had the strongest threats to their physical safety during the disaster, who lost their belongings or house or who had to relocate with their families as a result of the disasters are the most likely to experience long-term difficulties, she says.

Reminders of the disaster can also be overwhelming for children, says clinical child psychologist Merritt 'Chip' Schreiber, PhD, who works in children and youth services at the Orange County Health Care Agency in California. In their work with children who survived the 1993 Laguna Beach fire, Schreiber and his colleagues found that many became anxious just by high winds, which fueled the rapid spread of the fire across the small community. And in his follow-up work eight months after the disaster, he found that children who had lost their homes in the fire were far more likely to have developed symptoms of PTSD and depression.

But children are often reluctant to talk about their own feelings following a disaster, particularly because they?re well aware of the emotional struggles their parents and other adults are going through.

LaGreca, Gurwitch and Schreiber have identified several steps that psychologists and other mental health providers can take to identify and help children with PTSD after a disaster. They can, for example:

? Meet with parents, teachers and other adults who look after the children, to help them learn how to spot trauma-related behavior and to help the youngsters talk about and understand their feelings.

? Make sure children get back to their daily routine, such as school, sports and playtime with friends, so they can better see that life can continue as it did before the disaster.

? Give children the opportunity in the classroom and at home to talk about the disaster, and to develop ways to manage their stress. Teachers, for example, can lead a class discussion in which students talk about the positive aspects of their lives.

LaGreca and her colleagues have listed these and other tips in her booklet, 'Helping Children Prepare for and Cope with Natural Disasters: A Manual for Professionals Working with Elementary School Children.' The publication was funded by BellSouth Foundation and is based on the research of Hurricane Andrew victims.

The booklet offers a variety of tips on how to identify and help children at risk for extensive emotional problems resulting from a disaster. It suggests, for example, that schools expose children to discussions on the disaster?a technique proven to reduce the emotional distress that follows such events.

Psychologists also believe that children can effectively process their trauma if they express their emotions through writing or drawing.

In fact, many organizations are developing online forums about disasters for children. Lennis Echterling, PhD, associate professor of psychology at James Madison University in Virginia, and his colleagues, have crafted a disaster-intervention web site, 'Disaster Stuff for Kids' (http://www.jmu.edu/psychologydept/4kids.htm), that contains reading material on disasters for children and links to other relevant web sites.

And the site will soon include a 'My Story' page that will allow children to share their thoughts and experiences about a disaster online.

The booklet,'Helping Children Prepare for and Cope With Natural Disasters,' can be obtained by sending a written request to Annette LaGreca, PhD, Box 249229, University of Miami, Coral Gables, FL 33124.