DISASTERS
Needs of Stressed Youth Important
Once the water recedes, mud is hauled away and
families are reunited with those who survived hurricanes Katrina and
Rita, most of the displaced residents will be focused on finding new
places to live and work.
But it will be equally important to pay attention to
the effects of these vast disruptions on the mental health of children
whose lives were torn apart.
In an almost prophetic coincidence, in the September
issue of the journal Pediatrics, professionals from the American Academy
of Pediatrics published a 10-page report to help pediatricians deal with
the psychosocial effects of traumatic events -- natural disasters and
acts of terrorism -- on children of all ages.
The report, by the academy's Committee on Psychosocial
Aspects of Child and Family Health, and its Task Force on Terrorism, was
compiled in response to the terrorist attacks on Sept. 11, 2001. But it
could not have come out at a more appropriate time.
Dr. Joseph F. Hagan Jr., a pediatrician in Burlington,
Vt., headed both the committee and the task force. In his view, the job
ahead is similar to that faced by those trying to address the needs of
children after Sept. 11, even though the catastrophes resulted from an
act of nature, not a deliberate act of terrorism, and there are many
child survivors to care for.
`PROFOUND SADNESS'
"The children will have posttraumatic stress disorder, anxiety and
depression, and some will have bereavement issues," Hagan said in an
interview. "They've lost their homes, neighbors, pets, friends and some
have lost parents and grandparents -all factors that can lead to
profound sadness."
At the same time, parents whose lives were affected
may themselves experience emotional problems that can make it difficult
for them to recognize and cope with the mental health needs of their
children.
"If a parent has a sense of hopelessness, that
parent's ability to attend to a child's needs are compromised," Hagan
noted. And parents who will have to find a new life for themselves and
their families "are not as likely to be available to their children and
sensitive to their needs," he said.
The report states: "Any effect of trauma on key or
trusted adults can result in magnified psychological effect on the
children they care for. An adult's emotional problems can add to a
child's fear. Distressed adults may fail to recognize a child's
distress."
Under these circumstances, he said, "We wouldn't want
parents to have to figure it out.
"It's the role of communities, family doctors,
pediatricians and schools to anticipate the mental health needs of
children," he explained. And they must prepare to deal with these needs,
he said.
"We lack a cohesive health care system in this
country, particularly with regard to mental health," Hagan said. "We
have inadequate mental health services for children, and it's much
harder for children to access these services than it is for adults."
Hagan said the first task was to get shelter for
families and the second was to get parents jobs so they could have some
sense of autonomy and control over their lives.
"This is important to a child's sense of safety," he
said. "If parents are frantic because of their own losses and needs,
it's pretty hard for children to be protected."
Equally important is to get children in school as
quickly as possible.
"School is what's supposed to happen in September,"
Hagan noted, and returning to school restores a sense of normalcy for
children.
Even in the best of circumstances, children who have
been the victims of devastating natural disasters like the back-to-back
hurricanes are likely to experience emotional distress that can affect
their behavior and mood for months to come.
"Parents and caregivers can expect children to respond
to disaster in distinct stages," the report states. "The first stage,
immediately after the disaster, includes reactions of fright, disbelief,
denial, grief, and feelings of relief if loved ones have not been
harmed."
The second stage comes a few days to several weeks
after the disaster. It might include regression to an earlier stage of
development, anxiety, fear, sadness and depression, hostility and
aggression toward others, apathy, withdrawal, sleep disturbances,
psychosomatic symptoms like stomachaches, a pessimistic view of the
future and play acting that recreates aspects of the event.
Children with marked distress are in urgent need of
counseling, the report notes. Professional help is also needed for
children with stress reactions that persist for longer than a month, or
who are at risk for developing a persistent post-traumatic reaction or
"violent or delinquent behaviors later in life," the report notes.
Even infants and toddlers can be adversely affected by
disasters. For infants, the reaction can be an increase in crying and
irritability, separation anxiety and an exaggerated startle response.
For toddlers and preschoolers, signs of trouble may include sleep
terrors and nightmares, helplessness, clinging behavior and temper
tantrums.
School-age children may re-enact the trauma through
play, behave aggressively, become withdrawn or apathetic, develop
psychosomatic symptoms or behavior problems, and experience sleep
disturbances and regressive behaviors like separation anxiety.
Traumatized children may become hypervigilant, always
on the alert for possible danger, Hagan said. They may be afraid to go
to go to sleep or to school lest they get washed away while their
mothers are somewhere else.
Even young children distant from the trauma can be
adversely affected, thinking a hurricane will next hit where they live,
Hagan said. "They need to be reassured that Katrina was far, far away."
EXCEPTIONALLY VULNERABLE
Adolescents, who are already going through a difficult period of
development, are particularly vulnerable to the effects of a disaster,
the report states. They may become withdrawn, apathetic and depressed.
They may also engage in risk-taking behaviors like drug abuse and sexual
behaviors as a means of coping with trauma-induced distress.
On the other hand, some adolescents may try to mask or
withhold symptoms of distress and even try to protect other family
members who are upset. As a result, parents may underestimate the
effects of the disaster on adolescents and fail to get them the help
they need.
The report also points out that boys and girls tend to
react differently to a disaster. Girls commonly develop symptoms like
anxiety and mood disturbances, while boys are more likely to show
behavioral symptoms and take longer to recover than girls.
Most important, the report concludes, is to "allow our
children to have hope."
"Even children living in unsafe communities or those
affected by prejudice, racism, or violence depend on trusted adults to
feel safe or protected so that they might anticipate a less stress-laden
future," it says.
Achieving this goal will depend on the actions taken
in the coming weeks by federal, state and community governments, schools
and health-care professionals, not just by parents who themselves have
been traumatized.
Jane Brody
4 October 2005
http://www.theledger.com/apps/pbcs.dll/article?AID=/20051004/NEWS/510040304/1021
