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Catastropic Events

Disasters and catastrophes are unforeseen, time limited, highly disruptive events that affect large groups of people. Adults coping with catastrophic events may not realize that exposure to these chaotic circumstances, as well as caregiver’s own responses can negatively affect children of all ages. Prior to September 11, far fewer resources were available to children exposed to catastrophic events.

Disasters can be natural or man made. Examples of natural disasters include floods, tornados, volcanoes, hurricanes, earthquakes, etc. Human caused disasters include terrorist acts, technological accidents, school shootings, hijackings and accidents such as car and train derailments.

Violent catastrophes can result in death and injury to children and loved ones and cause people to question their safety and security. One of the after-effects of man-made disasters, such as war or terrorism, is that the community must continue to brace itself and remain “on alert”, contributing to greater anxiety. (Webb, 2004) While researchers have determined that children in close physical proximity to a disaster are most severely effected (Pynoos, 1996) , children also can be effected by the anxiety experienced by the adults around them. The news media often shows violent images which can be very disturbing to children who may not have the emotional maturity to understand the scope of the event.

One of the greatest challenges that caregivers face after a trauma lies in processing their own reactions as well as treating children with empathy and care. It is essential that caregivers take advantage of resources such as physicians, educators, mental health providers and community support. In the aftermath of a catastrophic event, children, in a developmentally appropriate way, need to be supported in recognizing and dealing with their feelings.

Much more attention has been paid to the ways children respond to trauma in the past decade than in previous years, and many service agencies, hospitals and schools have implemented disaster-preparedness programs to support children and families. Interestingly, research comparing children’s anxiety levels before and after 9/11 found that children were less stressed after 9/11 due to the increased attention that they have received since the tragedy. (Smith, 2003) This may confirm that children do benefit from adult care and intervention.

The American Psychological Association offers these hints to help in guiding parents dealing with disasters.

The emotional aftermath of a catastrophic event can often leave parents and children confused and distressed, especially if loved ones are lost. Post traumatic stress disorder, or PTSD is a severe reaction to trauma. PTSD was previously associated mainly with adults (most commonly identified in war veterans) who have witnessed, lost loved ones or survived extremely disturbing events and are experiencing painful emotional after-effects.

Since 9/11, mental health researchers have identified more American children with PTSD symptoms than any time in history. Presently, it is estimated that 10.5% of New York City schoolchildren are suffering from PTSD. (Hoven, Mandell, & Duarte, 2003) Due to their incomplete emotional development, babies, children and adolescents are extremely susceptible to anxiety. PTSD is expressed differently in children according to their developmental level, and for this reason, it must be assessed and treated according to a child’s maturity level. (Webb, 2004)

It isn’t always evident that a child might be experiencing any kind of post-traumatic effects. Some children are naturally more resilient than others and will suffer no ill effects; some will attempt to hide their feelings of fear or anxiety as a way of being supportive to the upset adults around them, whereas other children may take longer to show any noticeable trauma. (Early intervention for trauma and traumatic loss, 2004)

Children who have previously experienced traumatic events, such as family violence and community violence are statistically at a higher risk for painful after-effects. (Vogel & Vernberg, 1993) Parents are encouraged to pay attention to any changes in a child’s behavior following a catastrophic event. While all children are different and experience trauma differently, the following are some common responses to trauma sorted by age and developmental level.

Children under 5 tend to be heavily affected by their parent’s responses to trauma. Some children will experience intense fear of being away from parents, crying, screaming and some will often revert to behaviors of earlier stages, including bed-wetting, thumb-sucking and night terrors.

Children between the ages of 6 and 11 will often display disruptive behavior, aggression, depression, sleep disorders and nightmares. Some children in this age group will complain of physical problems without illness, such as stomach aches and schoolwork will often suffer.

Children between the ages of 11 and 17 often have post-traumatic responses not unlike those of adults. Nightmares, flashbacks, depression, isolation, avoidance of reminders of the event, sleep disturbances, suicidal feelings and feelings of guilt are all common responses when an adolescent is experiencing difficulty related to a traumatic event. (Helping Children and Adolescents Cope with Violence and Disasters, 2001)

Some of the warning signs that your child may be suffering from PTSD may be found here.

References:

Litz, B.T., (Ed.) Early intervention for trauma and traumatic loss. (2004). New York, NY: Guilford Press.

Helping Children and Adolescents Cope with Violence and Disasters . (2001). Retrieved 5/24, 2004, from http://www.nimh.nih.gov/publicat/violence.cfm

Hoven, C. W., Mandell, D. J., & Duarte, C. S. (2003). Mental health of New York City public school children after 9/11: An epidemiologic investigation. In S. Coates, J. L. Rosenthal & D. S. Schecter (Eds.), September 11: Trauma and Human Bonds. Hillsdale, NJ: The Analytic Press.

Pynoos, R. S. (1996). Exposure to catastrophic violence and disaster in childhood. In Pfeffer, Cynthia R (Ed) (1996) Severe stress and mental disturbance in children (pp 181-208) xxiv, 673pp.

Smith, D. (2003, May). Everyday fears trump worries about terrorism. APA Monitor, 34, 22.

Vogel, J. M., & Vernberg, E. M. (1993). Psychological responses of children to natural and human-made disasters: I. Children's psychological responses to disasters. Journal of Clinical Child Psychology, 22(4), 464-484.

Webb, N. B. (2004). Mass trauma and violence : helping families and children cope. New York: Guilford Press.

Relevant Websites

• National Child Traumatic Stress Network
• National Institute of Mental Health ’s Trauma page
• American Psychological Association’s article on Helping Children Cope with Natural Disasters
• National Center for Disaster Preparedness
• National Center for PTSD
• American Academy of Experts in Traumatic Stress
• American Academy of Pediatrics Children and Trauma page
• American Psychological Association’s Trauma page
• SAMHSA’s Page on Emergency Mental Health and Traumatic Stress
• For more websites, see:
  NCCEV’s Trauma links

Statistics

• In the United States alone from 1996 to 1998 there were more than 5 million children exposed to some form of severe traumatic event such as physical abuse, domestic and community violence, motor vehicle accidents, chronic painful medical procedures and natural disasters (Perry, B.D. Traumatized children: how childhood trauma influences brain development. Journal of the California Alliance for the Mentally Ill 11(1): 48-51, 2000)
• Twenty million (or more) children with PTSD are among the least understood, under-studied and inconsistently served groups in the United States. (Perry, B.D. Traumatized children: how childhood trauma influences brain development. Journal of the California Alliance for the Mentally Ill 11(1): 48-51, 2000)
• Rates of PTSD identified in childhood range from 2 percent after a natural disaster (tornado), 28% after an episode of terrorism (mass shooting), and 29 % after a plane crash (Smith EM, North CS, Spitznagel EL Post-traumatic stress in survivors of three disasters. Journal of Social Behavior and Personality, 8(5): 353-68, 1993.)
• 26.5 % of New York City public school students were suffering from at least one mental health problem in 2002 as a result of the September 11 terrorist attacks. (Hoven, CW, Duarte, CS, Lucas CP, et al. Effects of the World Trade Center Attack on NYC Public School Students – Initial Report to the New York City Board of Education. New York: Columbia University Mailman School of Public Health – New York State Psychiatric Institute and Applied Research and Consulting, LLC., 2002)
• Among an estimated 10.5% (75,000) of students suffering from symptoms of posttraumatic stress disorder six months after 9/11, including children who were not directly affected by the event, the prevalence of stress was higher among children who spent more time learning about the attacks from TV than children who spent less time. (Applied Research and Consulting LLC, Columbia University Mailman School of Public Health, and New York State Psychiatric Institute. Effects of the World Trade Center attack on New York City Public School students: Initial report to the New York City Board of Education (May 6, 2002) pdf])

In the Literature

For Parents and Teachers

Parent’s Guide to Talking to their Children About War pdf

Guía para Padres, para hablar con sus hijos acerca de la Guerra pdf

Teachers' Guide for Talking with their Students about War pdf

In the Aftermath of Terrorism: A Summary pdf

Parent's Guide for Talking with their Children pdf

Guía para Padres para hablar con sus hijos pdf

Teachers' Guide for Talking with their Students pdf

School Administrators' Guide for Talking to their Students and Staff pdf

Parent's Guide to Talking with Children about Death pdf

Responding to Children about Anthrax pdf

Teaching young children in violent times. Educators for Social Responsibility.

For Professionals

Reports

• Children and the news: coping with terrorism, war and everyday violence. Key Facts Spring 2003. Kaiser Family Foundation
• Mobilizing Trauma Resources for Children pdf. William Harris, Ph.D., Frank Putnam, M.D., John A. Fairbank, Ph.D. January 8, 2004 . Presented in part at the meeting of the Johnson & Johnson Pediatric Institute: Shaping the Future of Children's Health, SanJuan, Puerto Rico , February 12-16, 2004

Books

• Children in a violent society. Joy D. Osofsky. New York : Guilford Press, 1997.
• Early intervention for trauma and traumatic loss. Brett T. Litz. New York : Guilford Press, 2004.
• Helping children cope with disasters and terrorism. Annette M. La Greca. Washington , DC : American Psychological Association, 2002.
• Mass trauma and violence: Helping families and children cope. Nancy Boyd Webb. New York : Guilford Press, 2004.
• Young children and trauma: intervention and treatment. Joy D. Osofsky, editor. New York : Guilford Press, 2004.

Journal Articles

• Bhutta, Zulfiqar Ahmed. The impact of war on children: Some lessons from the Afghan conflict. [Chapter] Gupta, Rajinder M. (Ed); Parry-Gupta, Deepa S. (Ed). (2003). Children and parents: Clinical issues for psychologists and psychiatrists. (pp. 207-222). London, England: Whurr Publishers, Ltd.. xv, 283pp.
• Fremont, Wanda P. Childhood reactions to terrorism-induced trauma: A review of the past 10 years. [Peer Reviewed Journal] Journal of the American Academy of Child & Adolescent Psychiatry. Vol 43(4) Apr 2004, 381-392.
• Kreuger, Larry; Stretch, John. Identifying and helping long term child and adolescent disaster victims: Model and method. [Peer Reviewed Journal] Journal of Social Service Research. Vol 30(2) 2003, 93-108.
• Thabet, Abdel Aziz Mousa; Abed, Yehia; Vostanis, Panos. Comorbidity of PTSD and depression among refugee children during war conflict. [Peer Reviewed Journal] Journal of Child Psychology & Psychiatry. Vol 45(3) Mar 2004 , 533-542.
• Myers-Bowman, Karen S; Walker, Kathleen; Myers-Walls, Judith A. A cross-cultural examination of children's understanding of the enemy. [Peer Reviewed Journal] Psychological Reports. Vol 93(3) Dec 2003, 779-790.
• Marshall, Randall D; Galea, Sandro. Science for the community: Assessing mental health after 9/11. [Peer Reviewed Journal] Journal of Clinical Psychiatry. Vol 65(Suppl1) 2004, 37-43.
• Kolaitis, G; Kotsopoulos, J; Tsiantis, J; Haritaki, S; Rigizou, F; Zacharaki, L; Riga, E; Augoustatou, A; Bimbou, A; Kanari, N; Liakopoulou, M; Katerelos, P. Posttraumatic stress reactions among children following the Athens earthquake of September 1999. [Peer Reviewed Journal] European Child & Adolescent Psychiatry. Vol 12(6) Dec 2003, 273-280.
• Qouta, Samir; Punamaki, Raija-Leena; Sarraj, Eyad El. Prevalence and determinants of PTSD among Palestinian children exposed to military violence. [Peer Reviewed Journal] European Child & Adolescent Psychiatry. Vol 12(6) Dec 2003, 265-272.
• Newman, Martin. Helping children cope with disasters and terrorism. [Peer Reviewed Journal] Journal of Child Psychology & Psychiatry & Allied Disciplines. Vol 45(1) Jan 2004, 172.
• Barenbaum, Joshua; Ruchkin, Vladislav; Schwab-Stone, Mary. The psychosocial aspects of children exposed to war: practice and policy initiatives. [Peer Reviewed Journal] Journal of Child Psychology & Psychiatry & Allied Disciplines. Vol 45(1) Jan 2004, 41-62.
• Kilic, Emine Zinnur; Ozguven, Halise Devrimci; Sayil, Iaik. The psychological effects of parental mental health on children experiencing disaster: The experience of Bolu earthquake in Turkey . [Peer Reviewed Journal] Family Process. Vol 42(4) Win 2003, 485-495.
• Oppenheimer, Louis; Kuipers, Ilona. Filipino children's understanding of peace, war, and strategies to attain peace. [Peer Reviewed Journal] Peace & Conflict: Journal of Peace Psychology. Vol 9(3) 2003, 235-257.
• Almqvist, Kjerstin; Broberg, Anders G. Young children traumatized by organized violence together with their mothers - The critical effects of damaged internal representations. [Peer Reviewed Journal] Attachment & Human Development. Vol 5(4) Dec 2003, 367-380.
• Maxted, Julia. Children and Armed Conflict in Africa . [Peer Reviewed Journal] Social Identities. Vol 9(1) Mar 2003, 51-72.
• Wessells, Michael; Monteiro, Carlinda. Healing, social integration, and community mobilization for war-affected children: A view from Angola . [Chapter] Krippner, Stanley (Ed); McIntyre, Teresa M. (Ed). (2003). The psychological impact of war trauma on civilians: An international perspective. Psychological dimensions to war and peace. (pp. 179-191). Westport, CT, US: Praeger Publishers/Greenwood Publishing Group, Inc. xiv, 327pp.
• Barath, Arpad. Cultural art therapy in the treatment of war trauma in children and youth: Projects in the former Yugoslavia . [Chapter] Krippner, Stanley (Ed); McIntyre, Teresa M. (Ed). (2003). The psychological impact of war trauma on civilians: An international perspective. Psychological dimensions to war and peace. (pp. 155-170). Westport, CT, US: Praeger Publishers/Greenwood Publishing Group, Inc. xiv, 327pp.
• Evans, Linda Sue Garner. Theoretical constructs of post traumatic stress disorder as assessed in children in a natural disaster involving tornadoes in their communities. [Dissertation Abstract] Dissertation Abstracts International: Section B: the Sciences & Engineering. Vol 64(2-B), 2003, 951, US: Univ Microfilms International.
• Ardila-Rey, Alicia. Colombian children's ideas about peer-conflict resolution and peace making: The effects of war and violence on children's moral reasoning. [Dissertation Abstract] Dissertation Abstracts International: Section B: the Sciences & Engineering. Vol 64(1-B), 2003, 440, US: Univ Microfilms International.
• Feerick, Margaret M; Prinz, Ronald J. Next steps in research on children exposed to community violence or war/terrorism. [Peer Reviewed Journal] Clinical Child & Family Psychology Review. Vol 6(4) Dec 2003, 303-305.
• Joshi, Paramjit T; O'Donnell, Deborah A. Consequences of child exposure to war and terrorism. [Peer Reviewed Journal] Clinical Child & Family Psychology Review. Vol 6(4) Dec 2003, 275-292.
• Shaw, Jon A. Children exposed to war/terrorism. [Peer Reviewed Journal] Clinical Child & Family Psychology Review. Vol 6(4) Dec 2003, 237-246.
• Prinz, Ronald J; Feerick, Margaret M. Children exposed to community violence or war/terrorism: Current status and research directions-introduction. [Peer Reviewed Journal] Clinical Child & Family Psychology Review. Vol 6(4) Dec 2003, 221-222
• Fivush, Robyn; Sales, Jessica McDermott; Goldberg, Amy; Bahrick , Lorraine ; Parker, Janat. Weathering the storm: Children's long-term recall of Hurricane Andrew. [Peer Reviewed Journal] Memory. Vol 12(1) Jan 2004, 104-118.
• Tobias-Nahi, Christina Safiya; Garfield, Eliza N. An Islamic school responds to September 11. [Chapter] Books, Sue (Ed). (2003). Invisible children in the society and its schools (2nd ed.). (pp. 13-33). Mahwah, NJ, US: Lawrence Erlbaum Associates, Publishers. xxiv, 258pp.
• Books, Sue. Introduction: September 11, welfare 'reform,' educational opportunity, and the lives of children. [Chapter] Books, Sue (Ed). (2003). Invisible children in the society and its schools (2nd ed.). (pp. 1-12). Mahwah, NJ, US: Lawrence Erlbaum Associates, Publishers. xxiv, 258pp.
• Gerrity, Ellen T; Steinglass, Peter. Relocation stress following catastrophic events. [Chapter] Ursano, Robert J. (Ed). Uniformed Services U of the Health Sciences; Dept of Psychiatry; Ctr for the Study of Traumatic Stress; et al. (2003). Terrorism and disaster: Individual and community mental health interventions. (pp. 259-286). New York, NY, US: Cambridge University Press. xii, 349pp.
• Pfefferbaum, Betty. The children of Oklahoma City . [Chapter] Ursano, Robert J. (Ed). Uniformed Services U of the Health Sciences; Dept of Psychiatry; Ctr for the Study of Traumatic Stress; et al. (2003). Terrorism and disaster: Individual and community mental health interventions. (pp. 58-70). New York, NY, US: Cambridge University Press. xii, 349pp.
• Shaw, Jon A; Harris, Jesse J. Children of war and children at war: Child victims of terrorism in Mozamique. [Chapter] Ursano, Robert J. (Ed). Uniformed Services U of the Health Sciences; Dept of Psychiatry; Ctr for the Study of Traumatic Stress; et al. (2003). Terrorism and disaster: Individual and community mental health interventions. (pp. 41-57). New York, NY, US: Cambridge University Press. xii, 349pp.
• Hoven, Christina W; Mandell, Donald J; Duarte, Cristiane S. Mental health of New York City Public School children after 9/11: An epidemiologic investigation. [Chapter] Coates, Susan W. (Ed); Rosenthal, Jane L. (Ed); et al. (2003). September 11: Trauma and human bonds. Relational perspectives book series. (pp. 51-74). Hillsdale, NJ, US: Analytic Press, Inc. xiv, 293pp.
• Coates, Susan W; Schechter, Daniel S; First, Elsa. Brief interventions with traumatized children and families after September 11. [Chapter] Coates, Susan W. (Ed); Rosenthal, Jane L. (Ed); et al. (2003). September 11: Trauma and human bonds. Relational perspectives book series. (pp. 23-49). Hillsdale, NJ,> US: Analytic Press, Inc. xiv, 293pp.
• Lubit, Roy; Eth, Spencer. Children, disasters, and the September 11th World Trade Center attack. [Chapter] Ursano, Robert J. (Ed); Norwood , Ann E. (Ed). (2003). Trauma and disaster responses and management. Review of psychiatry, vol. 22 no. 1. (pp. 63-96). Washington, DC, US: American Psychiatric Publishing, Inc. xviii, 169pp.
• Saylor, Conway F; Cowart, Brian L; Lipovsky, Julie A; Jackson, Crystal; Finch, A. J. Jr. Media exposure to September 11: Elementary school students' experiences and posttraumatic symptoms. [Peer Reviewed Journal] American Behavioral Scientist. Vol 46(12) Aug 2003, 1622-1642.
• Berberian, Marygrace. Communal Rebuilding After Destruction: The World Trade Center Children's Mural Project. [Peer Reviewed Journal] Psychoanalytic Social Work. Vol 10(1) 2003, 27-41.
• Yurtbay, Tuelin; Alyanak, Behiye; Abali, Osman; Kaynak, Nimet; Durukan, Melek. The Psychological Effects of Forced Emigration on Muslim Albanian Children and Adolescents. [Peer Reviewed Journal] Community Mental Health Journal. Vol 39(3) Jun 2003, 203-212.
• Pfefferbaum, Betty; Seale, Thomas W; Brandt, Edward N. Jr; Pfefferbaum, Rose L; Doughty, Debby E; Rainwater, Scott M. Media exposure in children one hundred miles from a terrorist bombing. [Peer Reviewed Journal] Annals of Clinical Psychiatry. Vol 15(1) Mar 2003, 1-8. Kluwer
• Miller, Laurence. Family therapy of terroristic trauma: Psychological syndromes and treatment strategies. [Peer Reviewed Journal] American Journal of Family Therapy. Vol 31(4) Jul-Sep 2003, 257-280.
• Goldin, Stephen; Levin, Lilian; Ake Persson, Lars; Haeggloef, Bruno. Child war trauma: A comparison of clinician, parent and child assessments. [Peer Reviewed Journal] Nordic Journal of Psychiatry. Vol 57(3) May 2003, 173-183.
• Ackil, Jennifer K; Van Abbema, Dana L; Bauer, Patricia J. After the storm: Enduring differences in mother-child recollections of traumatic and nontraumatic events. [Peer Reviewed Journal] Journal of Experimental Child Psychology. Vol 84(4) Apr 2003, 286-309.
• Wolmer, Leo; Laor, Nathaniel; Yazgan, Yanki. School reactivation programs after disaster: Could teachers serve as clinical mediators? [Peer Reviewed Journal] Child & Adolescent Psychiatric Clinics of North America. Vol 12(2) Apr 2003, 363-381.
• Laor, Nathaniel; Wolmer, Leo; Spirman, Smadar; Wiener, Ze'ev. Facing war, terrorism, and disaster: Toward a child-oriented comprehensive emergency care system. [Peer Reviewed Journal] Child & Adolescent Psychiatric Clinics of North America. Vol 12(2) Apr 2003, 343-361.
• Friedman, Matthew J; Foa, Edna B; Charney, Dennis S. Toward evidence-based early interventions for acutely traumatized adults and children. [Peer Reviewed Journal] Biological Psychiatry. Vol 53(9) May 2003, 765-768.
• Lubit, Roy; Rovine, Deborah; Defrancisci, Lea; Eth, Spencer. Impact of trauma on children. [Journal Article] Journal of Psychiatric Practice. Vol 9(2) Mar 2003, 128-138.
• Pfefferbaum, Betty; North, Carol S; Doughty, Debby E; Gurwitch, Robin H; Fullerton, Carol S; Kyula, Jane. Posttraumatic stress and functional impairement in Kenyan children following the 1998 American embassy bombing. [Journal Article] American Journal of Orthopsychiatry. Vol 73(2) Apr 2003, 133-140.
• Hamada, Roger S; Kameoka, Velma; Yanagida, Evelyn; Chemtob, Claude M. Assessment of elementary school children for disaster-related posttraumatic stress disorder symptoms: The Kauai recovery index. [Journal Article] Journal of Nervous & Mental Disease. Vol 191(4) Apr 2003, 268-272.
• Pfefferbaum, Betty; Sconzo, Guy M; Flynn, Brian W; Kearns, Lauri J; Doughty, Debby E; Gurwitch, Robin H; Nixon, Sara Jo; Nawaz, Shajitha. Case finding and mental health services for children in the aftermath of the Oklahoma city bombing. [Journal Article] Journal of Behavioral Health Services & Research. Vol 30(2) Apr-Jun 2003, 215-227.

© 2003 National Center for Children Exposed to Violence (NCCEV)
Modification: March 20, 2006