Children Coping with Terrorism and Disasters: Diagnosis & Treatment

On the last track, we discussed three differences among the different types of natural disasters, using the specific examples of hurricanes and earthquakes, and how they may affect children’s psychological well being.  These three differences are, predictability, duration, and the scale of the disaster.  We also discussed three similarities common to all types of natural disasters, including cost and disruption, effect on families, and effects on children.

On this track, we will discuss three important concerns in treating children in recovery from a natural disaster.  The three important concerns we will discuss are specific obstacles in treating children recovering from natural disaster, interventions in the initial recovery period, and interventions in the long-term recovery period.

3 Important Concerns in Treating Children in Recovery from a Natural Disaster

Concern #1 - Recognizing Specific Obstacles
I have found that a first important concern in treating children recovering from natural disasters is recognizing specific obstacles that may arise in treating these children.  The first major obstacle, of course, is that the significant people in the children’s lives may also be affected by the disaster, and may not be available to provide help and support.  Additionally, important adults in the childrens’ lives may underestimate the children’s distress following a disaster, perhaps because these adults are also experiencing trauma.  Finally, support from outside of the community, for example assistance from the Red Cross or a neighboring community, may dissipate quickly.

Concern #2 - Interventions in the Initial Recovery Period
A second important concern in treating children is interventions in the initial recovery period, which takes place between one day and three months after the event.  A first intervention that is usually appropriate on a broader scale is initiating community or school based interventions that target youth in affected areas, and aim to identify those children with a high incidence of PTSD symptoms. 

Vernberg and Vogel's 3-Pronged Approach
Vernberg and Vogel encourage early interventions to take the form of:
-- classroom and small group activities,
-- family approaches, and
-- individual treatment. 
The purpose of this three pronged approach is to provide information and help normalize the children’s reactions to the disaster, and help the children return to a sense of routine and normalcy. 

Many of the types of interventions that have been evaluated primarily involve debriefing efforts, or critical incident stress debriefing (CISD).  CISD is a crisis intervention designed to relieve and prevent trauma related distress in ‘normal’ people who are experiencing abnormally stressful events or disasters.  These debriefings provide opportunities for children to ventilate feelings, normalize their responses to the disaster, and learn about common psychological reactions in the context of a supportive group.   However, the evidence to date suggests that single incidents of debriefing are not sufficient following a disaster to help alleviate symptoms of post traumatic stress in children, and multiple sessions will likely be necessary.

Short-Term Intervention - Massage Therapy
One intervention that has proved definitively successful, at least in the short term, is massage therapy for children.  Massage therapy has been shown to alleviate symptoms of anxiety and depression in elementary school children following a hurricane.  Field, Seligman, Scafidi, and Schanberg studied 60 children who had exhibited symptoms of PTSD in the month following Hurricane Andrew. 

Half of the children were in a control group, and watched a short video while sitting in the lap of a researcher, otherwise known as the video-attention control condition.  The experimental group received 30-minute back massages twice a week.  Children in the experimental group reported less anxiety and depression, evidenced lower salivary cortisol levels, and were observed to be more relaxed following treatment.

Concern #3 - Interventions in the Long-Term Recovery Period
A third concern regarding treating children is interventions in the long-term recovery period.  Relatively few controlled investigations have been conducted of youth following disasters, even though a significant number of youth report moderate to severe levels of posttraumatic stress a year or more after a disaster. 

Of approaches that have been studied, two that have shown to be effective are a trauma and grief focused approach, and a cognitive-behavioral therapy approach.  Both of these approaches have as a central notion the idea that trauma victims need to be reexposed to the traumatic event, often through recalling images, and be allowed to emotionally process the event in a safe, controlled setting.

Five Elements of the Trauma and Grief Focused Approach

1. reconstructing and reprocessing the traumatic event, in part by clarifying distortions and misattributions, and addressing the resulting avoidance and maladaptations.
2. identifying traumatic reminders and assisting children with developing tolerance and increasing social support during and after the reminders.
3. coping with stresses and adversities by encouraging proactive measures to cope with changes and losses resulting from the disaster
4. handling bereavement by helping the bereaved reconstitute a nontraumatic mental image of the deceased person
5. assessing developmental impact by identifying missed developmental opportunities and promoting normal developmental tasks.

By three years post disaster, adolescents treated with a trauma and grief focused approach showed a significant decrease in PTSD symptoms over time, whereas their nontreated peers reported an increase in symptoms over time.

Six Elements of the Cognitive-Behavioral Approach  

1. anxiety management training
2. relaxation training
3. anger coping
4. cognitive training for dealing with PTSD intrusions
5. developing a stimulus hierarchy that is based on traumatic reminders
6. narrative, gradual exposure to the trauma along with corrective information regarding distortions and misattributions

The cognitive behavioral program was supplemented in order to encourage treatment generalization by giving homework assignments.  After completing the treatment program, 57% of the children no longer met the criteria for PTSD.  At the six month follow up, 86% no longer met the criteria for PTSD.

Think of a child you are currently treating for PTSD syptomatology following a natural disaster.  Would trauma and grief focused therapy, or cognitive behavioral therapy be helpful in his or her long-term recovery period?

On this track, we have discussed three important concerns in treating children in recovery from a natural disaster.  The three important concerns are specific obstacles in treating children recovering from natural disaster, interventions in the initial recovery period, and interventions in the long-term recovery period.

On the next track, we will discuss a study conducted in 1994 that investigated the impact of a bushfire disaster in New South Wales, Australia.  The study also evaluated postdisaster screening methods for the children affected by the bushfire.
Reviewed 2023

Peer-Reviewed Journal Article References:
Felton, J. W., Cole, D. A., & Martin, N. C. (2013). Effects of rumination on child and adolescent depressive reactions to a natural disaster: The 2010 Nashville flood. Journal of Abnormal Psychology, 122(1), 64–73. 

Hamblen, J. L., Norris, F. H., Symon, K. A., & Bow, T. E. (2017). Cognitive behavioral therapy for postdisaster distress: A promising transdiagnostic approach to treating disaster survivors. Psychological Trauma: Theory, Research, Practice, and Policy, 9(Suppl 1), 130–136. 

Hansel, T., Osofsky, H., Speier, A., & Osofsky, J. (2019). Postdisaster recovery and resilience: The mediating influences of mental health and environmental quality of life. Traumatology. Advance online publication. 

Online Continuing Education QUESTION 12
What is CISD? To select and enter your answer go to CEU Test.