Natural disasters happen suddenly and cause devastation in the form of death, injury, and destruction. The Red Cross has recorded an average of 350 disasters per year in the last decade, a 75% increase from the average 200 disasters per year in the 1990s. In 2008, 326 natural disasters occurred around the world, killing 235,736 people, affecting 213,000,000 people, and causing an estimated $181,000,000,000 in damage (International Federation of Red Cross and Red Crescent Societies [Red Cross], 2009). Research has found that children are the most vulnerable to psychological trauma but their emotional needs are often neglected in the aftermath of a disaster (Vennema & Schroeder-Bruce, 2002). Additionally, children may be at risk of developing post-traumatic stress disorder (PTSD) resulting from the “experiencing, witnessing, or participation” in the disaster (American Academy of Child & Adolescent Psychiatry [AACAP], 2008). Parents, caregivers, and aid workers need to recognize the psychological effect disasters have on children to help them cope with emotional trauma and prevent long-term repercussions.
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With the rise in natural disasters and the terrorist attack of September 11, 2001, researchers have been observing how children respond to disasters. A child’s cognitive, physical, and social development influences his or her understanding of the disaster and potential trauma caused by it (American Academy of Pediatrics [AAP], 1999). Because of this, the role of child development will be investigated in this paper. Finally, children are not static but are influenced by their family, community, and national institutions. While research often recognizes the effect these structures have on a child’s development and disaster response, none have examined how each of these institutions interacts to influence a child’s response after a disaster. As a result, this paper will also analyze the literature to examine the effects of disasters on these institutions, and therefore children’s disaster response.
Even though natural disasters are today more common than before, adults often do not recognize their prevalence or impact on children. Shen & Sink (2002) examined the effects of disasters on school-age children and the prevalence of disaster interventions and preparation among school counselors. The researchers found that children may reenact their feelings or display their mourning through their play, especially with items associated with the event. Children may struggle with how to express their emotions and thoughts about a disaster. Parents, therefore, may not help their children cope because they are unaware of their children’s emotional needs. The authors note that changes in children’s behavior as a result of the trauma often decline over a period of a couple of months. However, children’s inability to cope with the disaster can have long-term effects on their development, education, and health. Shen and Sink (2002) also address the implications of disasters for school counselors and provide several suggestions for school-based disaster interventions. They note that schools provide support for children after a disaster and can be instrumental in the recovery process. For many children, being back in school restores a sense of normalcy, security, and order (Shen & Sink, 2002).
Through a qualitative descriptive study, Beuchesne, Kelley, Patdaughter, and Pickard (2002) investigated the effects of the September 11, 2001 World Trade Center attack on New York City children and how parents reacted to their children’s distress. By asking 88 school-age children and 51 parents of their response immediately after learning of the attack, they discovered that children felt unsafe, grief, empathy for victims, afraid of the future, and wanted retribution. Parents reported feeling unsure of how to help their child after a disaster. One significant feature of the study was the use of cognitive developmental theory to explain the developmental differences in children’s responses. For example, answers of how to avoid another attack included “don’t go in tall buildings,” “don’t fly on an airplane,” or “don’t grow up and become a pilot,” reflecting their concrete stage of development. The researchers also learned that older school-age children were concerned with the details of the attack (e.g. why, how) while younger children focused on how they felt. Similarly, school-age children understood the serious implications of the terrorist attack (loss of life, threat of war), while younger children remained focused on one aspect of the traumatic event, often how it influenced themselves directly These developmental characteristics may result in more intense reactions of grief and fear among school-age children in response to the disaster (Beuchesne et al., 2002).
Mercuri and Angelique (2004) conducted a literature review of 22 studies on natural, technological, and na-tech (natural and technological) disasters effects on children. Using content analysis, they coded for type of disaster, measurement instrument, instrument administration, and child’s age. The researchers found that children reported higher levels of post-traumatic stress disorder (PTSD) than parental measures. In addition, children whose lives had been endangered or directly witnessed the disaster had the highest rate of PTSD symptoms. This finding was especially apparent among the adolescent age group. No difference in stress level was found between the three categories of disaster. Based on these findings, Mercuri and Angelique (2004) argue that older children are more likely than younger children to be distressed after a disaster. The authors reason that older children’s cognitive development allows them to understand the implication and significance of the disaster on society as a whole, causing a deeper emotional response. The researcher’s findings also show that it is also important to ask children about their experiences after a disaster instead of relying on parental reports (Mercuri & Angelique, 2004).
Children’s development influences their response to a traumatic event. For young children, a disaster interferes with their attachment to caregivers, daily routine, and development of autonomy. School-age children, who understand the permanence of loss and the deeper implications of a disaster, may react to the disaster at a more profound emotional level. Adolescents are the most likely to respond in ways similar to adults. However, their developing identity, independence, and abstract thinking influence their reasoning and reactions to the disaster (Hagan, 2005).
In 1999, the American Academy of Pediatrics (AAP) recognized the effect development plays in children’s reaction in their report of the role of pediatricians in post-disaster interventions. In this statement, the authors assert that the most powerful effect of a disaster is the disruption it causes in children’s lives. Natural disasters suspend normal routines due to physical injury, damage of homes and schools, and loss of caregivers and loved ones. Children often respond to this loss in characteristic ways based on their age and development (see Appendix A). For example, a preschool age child may express their distress by regressing to behaviors previously outgrown while an adolescent may engage in risk-taking behaviors. Disasters often elicit responses of anxiety, depression, guilt, and sleep disturbances for both children and adolescents (AAP, 1999).
Murray (2006) also recognized how development affects the impact of disasters on children in his article addressing children’s psychosocial needs following a disaster. He noted that children’s reaction to a disaster depends mainly on the amount of destruction, loss, and the child’s age. Similar to the AAP (1999) statement, Murray (2006) mentioned how the death of a family member, physical injury, and destruction of home and school increases children’s reaction to the disaster. He argues that situations of separation and stress often elicit common reactions among children of similar ages (see Appendix A; Murray, 2006).
Due to disaster trauma, some children may display symptoms of posttraumatic stress disorder such as recurring nightmares, feelings of detachment, and physiological responses to exposure of reminders of the event. In their study of posttraumatic stress disorder (PTSD) among children after a disaster, Veenema and Schroeder-Bruce (2002) revealed that children’s wide range of emotional, psychosocial, and physiological response to disasters are often characteristic of the child’s level of development. Similar to the previous studies, the researchers noted that developmental growth may be disrupted by disaster trauma. However, the authors found that the most severe psychosocial reactions in children were associated with close proximity to the disaster, prolonged exposure to death and injury, and poor parental response. Veenema & Schroeder-Bruce, (2002) also illustrated how cognitive developmental theory (Piaget) and psychosocial developmental theory (Erikson) influence children’s trauma responses and appropriate interventions. For example, according to Piaget’s theory, elementary children think concretely, understand the use of symbols (one thing standing for another), begin to reason and think abstractly, and are less egocentric. Also at this age, school-age children seek to be industrious by being competent in skills and knowledge. Because of these developmental issues, a school-age child may exhibit social phobia or engage in repetitious traumatic play or retelling of the event in response to the trauma. For this reason, opportunities in which children can attempt “scary” things, such as returning to school, can restore children’s autonomy and sense of competency (Veenema & Schroeder-Bruce, 2002).
The ecological theory of development explores how a child’s family, community, and nation influence the growth and development of a child. Because a disaster affects all of these, the child’s response to a disaster will be shaped by how these structures also respond to a disaster. Below, this theory is applied to the literature to corroborate the role of the family, community, and nation in children’s disaster response.
Research has shown that children’s reactions to disasters are often intensified by their parent’s distress. During times of crisis, children are especially aware of a parent’s worries and stress (AACAP, 2008). Research has also shown that infant’s level of anxiety reflects their caregivers anxiety level (Murray, 2006). Parent’s response to a disaster expresses to children the severity of the situation and how they should respond (Beuchesne et al., 2006).Thus, parents must cope with the disaster to facilitate their children’s coping ability.
Disasters cause multiple losses for families. For example, a disaster may destroy a family’s home forcing them to live in temporary shelter, sever contact with friends and family, and lose material possessions. In addition, the disaster may affect a parent’s employment and livelihood. The ongoing stress from the secondary effects of the disaster makes children more vulnerable to stress and anxiety disorders (Federal Emergency Management Agency [FEMA], 2004). Existent stressors, such as poverty, are often exacerbated after a disaster as opportunities for shelter, food, and employment are further restricted. Families must not only cope with the effects of the disaster, but also these additional stressors (National Institute of Mental Health [NIMH], 2006).
Disasters can have long-lasting impacts on communities by disrupting occupations, altering environmental resources (food and water), and societal structures (education and government; Murray, 2006). Community leaders can help in the recovery process of families and children by being available to discuss emotions caused by the disaster, allow the use of buildings as gathering places and temporary shelters, and collaborating with relief agencies (NIMH, 2006). Community organizations involvement in disaster relief validates a family’s feelings of grief and loss caused by the disaster (AAP, 1999). Families who have support systems through religious institutions, community organizations, or extended family are more likely to be able to cope and understand their own feelings, therefore leading to their children’s increased coping ability (FEMA, 2004).
Natural disasters occur more often in developing countries and cause a greater proportion of deaths. In developing countries, a large percentage of the population lives in poverty in poorly constructed homes, with poor or non-existent warning systems, inadequate emergency response, rural locations, and a poor national economy (Kar, 2009). Because of these factors, developing countries are often more severely affected by natural disasters (Red Cross, 2009).
In contrast, children also appear to play an active role during disasters and recovery that impacts their families and community. Penrose and Takaki (2006) interviewed children in Thailand after the 2004 tsunami and found that children often helped in the initial emergency response. The children described how they acted instinctively during the disaster in saving themselves and others. They also helped by applying first aid, searching for lost family members, and collecting food and water. Their active involvement during the disaster relief and recovery helped minimize feelings of loss and grief (Penrose & Takaki, 2006).
Research has established the role of families and communities in children’s response to a disaster and often provides suggestions of how these individuals can help children recover (see Appendix B). For example, resources such as the NIMH and FEMA publications are available on-line to assist parents and adults helping children recover after a disaster. The publications discuss not only the role of adults and community in the recovery process, but also risk factors for vulnerability and common reactions of children by age. However, these publications fail to distinguish the effects these risk factors have on children’s response compared to one another. For example, is a child more severely affected by losing his parents or his home? Despite this limitation, these publications are a useful guide for adults trying to help children after a disaster. Unfortunately, these agencies do not have on-site disaster interventions for children. Some organizations though, have begun to implement interventions in disaster areas and evaluate their successfulness. Current intervention programs include Rainbow Center for Global Health’s Children in Disasters Project (Olness, Mandalakas, Pairojkul, Holsinger, Bothe, & Herran, 2007) and the Indian National Institute of Mental Health and Neuroscience’s “train the trainer” model program (Becker, 2006). However, one topic that is often neglected in these interventions is culture. Future efforts should focus on how cultural and religious beliefs may influence children’s response to a natural disaster and how these beliefs can be incorporated into disaster interventions.
Disasters interrupt children’s lives through loss, injury, and destruction of their home and community. This disruption leads to a loss of routine and normalcy, affecting children of all ages. Children’s development affects how children react to trauma caused by a disaster. Family and social support also influence children’s reactions to disaster trauma, while children’s response impacts these institutions as well. Parents and relief workers can facilitate children’s normal development and coping after a disaster by understanding how development, families, and support systems influence children’s response to a disaster.
Birth – 5 years old:
Detachment from caregiver
Separation anxiety; cling to caregivers
Heightened startle response
Changes in eating habits
Decreased level of responsiveness
Apathetic or passive
Increased temper tantrums
Regression in behavior
Somatic complaints (headaches, stomachaches)
6-12 years old:
Need to be with family at all times
Focus on direct consequences of disaster (e.g. no more school)
Need for details and information
Concerned for personal safety
Empathy for victims
Decline in school performance
Loss of interest or avoidance of activities
Somatic complaints (headaches, stomachaches)
12-18 years old:
Decline in school performance
Loss of interest in activities
Data from American Academy of Pediatrics, 1999, Hagan and the Committee on Psychosocial Aspects of Child and Family Health and the Task Force on Terrorism, 2005, and Murray, 2006
Answer questions honestly and do not avoid difficult questions
Provide relevant and honest information
Respect children’s readiness to discuss their thoughts and feelings
Encourage child to discuss the event when they are ready
Ask open-ended questions to clarify thoughts and feelings
Reassure child that he or she is safe and loved
Allow opportunities to mourn loss
Focus on the good that has come from the disaster and not just the trauma
Discuss potential secondary effects of a disaster (e.g. moving)
When possible, minimize the amount of exposure to the disaster area
Re-establish normal routine
Give children specific roles and tasks
Encourage parents to spend extra time with children
Use touch (e.g. hugs, comfort positioning) when appropriate
Reassure child that his/her feelings are normal
Provide consistency and routine
Watch for signs of post-traumatic stress disorder
Meet fundamental needs of child and family by providing food, shelter, and medical attention
Try to keep families intact and minimize periods of separation
Educate family on what has been done and what is being done to help
Empower family to provide for themselves
Coordinate relief services with other agencies in the community
Clarify and correct any misunderstandings about the disaster and its effects
Encourage families to utilize existing coping strategies, family, and social support networks
Data from Beuchesne, Kelley, Patsdaughter, & Pickard (2002) and Veenema & Schroeder-Bruce (2002)