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Understanding a Child's Stress through 4 Stages of Reactions to Trauma
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In the last section, we discussed four aspects of helping parents of children traumatized by secondary or media exposure to terrorist attacks learn how to manage their own fears when talking to their children. These four aspects are; explore your own fears first, express and acknowledge your fears, remember that your fears are not the same as the child’s, and deciding whether to bring up traumatic news with children.
In this section, we will discuss four stages of children's reactions to disasters and terrorism. These four stages are, the recoil phase, the postimpact phase, the recovery and reconstruction phase, and other reactions.
In 1972, a mining company's slag dam broke, and a huge torrent of water poured down the Buffalo Creek valley in West Virginia. 125 people died, and thousands were left homeless. Survivors from 160 families initiated legal action against the mining company, including claims for psychological damages. As a result of this legal action, the Buffalo Creek flood became one of the most studied disasters in U.S. history.
One of the biggest psychological impacts was on the children who survived the flood. Psychologists who studied the disaster found that even after two years had passed, children had intrusive thoughts concerning the flood and the days following. Child survivors of the flood also experienced extreme fear, a sense of the loss of safety, and often slept in their clothes.
As you know, it is commonly, and falsely, assumed that children are resilient and that their reactions to disasters, like the Buffalo Creek flood or the terrorist attacks of September 11, 2001, are short-lived. As a result, the adults in children's lives may not realize the extent of the child's stress, and the needs of children dealing with disasters are often neglected by adults who are having difficulty coping with the events themselves. Clearly, an understanding of how children react to disaster is invaluable.
In the rest of this section, we will begin our focused discussion of treating children coping with disaster and terrorism by discussing four stages of children's reactions to disasters. These four stages are, the recoil phase, the postimpact phase, the recovery and reconstruction phase, and other reactions.
4 Stages of Children's Reactions to Disater & Terrorism
♦ Stage # 1 - Recoil Phase
The first stage of children's reactions to disaster is the recoil phase, which describes the period immediately after the event. Although little research has investigated children's immediate reactions to disaster, various authors have described adult's reactions to traumatic events in the recoil phase as "psychic shock", characterized by shock, disbelief, feelings of being stunned and overwhelmed, and a sense of unreality.
I observed similar effects in Mikaela, age 7, in the aftermath of Hurricane Katrina in 2005. I first met Mikaela less than 48 hours after she had been forced to evacuate her home in New Orleans with her family. Mikaela stated, "Life feels kinda weird right now. I feel strange… kinda like I feel when I'm trying to wake up from a really bad dream."
♦ Stage # 2 - Postimpact Phase
The second stage of children's reactions to disaster is the postimpact phase, which takes place from days to weeks following the event. There is again a dearth of research into children's reactions in the postimpact phase, which is largely a result of the practical constraints of conducting research in the immediate aftermath of a major disaster.
During this time period, the two clinical diagnoses most likely to emerge are adjustment disorder and Acute Stress Disorder. As you know, according to the DSM, adjustment disorder in children is the development of emotional or behavioral symptoms in response to an identifiable stressor. Symptoms must appear within 3 months of the stressor and be 'clinically significant' to meet the diagnostic criteria. Symptoms of adjustment disorder include depressed mood, anxiety, and conduct disturbance.
In addition to adjustment disorder, a second clinical diagnosis that can emerge in children in the postimpact phase is acute stress disorder, which was introduced in the DSM-IV, back in 1994. Acute stress disorder in children is similar in many ways to PTSD in children, and both diagnoses require that the client is exposed to a traumatic event, and has a reaction of intense fear, helplessness, horror, disorganization, or agitated behavior.
However, acute stress disorder is characterized by more dissociative symptoms, such as numbing, detachment, or dissociative amnesia, than PTSD. Acute stress disorder is also characterized by an immediate onset and a shorter duration than PTSD. According to the DSM, disturbances attributable to acute stress disorder last for a minimum of 2 days and a maximum of 4 weeks, and symptoms must be evident within 4 weeks of the traumatic event.
♦ Stage # 3 - Recovery and Reconstruction Phase
In addition to the recoil phase and the postimpact phase, and third stage of children's reactions to disaster is the recovery and reconstruction phase that occurs from months to years after the event. The diagnosis most common to children in this stage in that of post traumatic stress disorder. As with acute stress disorder, for the diagnostic criteria in the DSM to be met, the child must have been exposed to an event that causes or is capable of causing death, injury, or threat to physical integrity and causes reaction of intense fear, helplessness, horror, disorganization, or agitated behavior.
In addition, specific criteria for three additional symptom clusters must be met: reexperiencing, avoidance or numbing, and hyperarousal. As you know, reexperiencing in children is thought to be exhibited by repetitive play with traumatic themes, or a reenactment of the traumatic events in play, drawings, or verbalizations. Symptoms of avoidance and numbing in children may include a lessened interest in play and daily activities, and feeling distant from friends and family.
According to a study by Lonigan, these avoidance symptoms are the least commonly reported aspects of PTSD in children, and thus may represent a useful diagnostic indicator of the presence of PTSD. Symptoms of hyperarousal may include difficulty sleeping or concentrating, irritability, angry outbursts, hypervigilance, and an exaggerated startle response. According to the DSM, PTSD symptoms must be present for at least one month, and must be accompanied by significant impairment in the child's functioning in order for a diagnosis of PTSD to take place.
♦ Stage # 4 -Other Reactions
A fourth stage of children's reactions to disasters is other reactions. As you know, the rates of comorbidity for depressive or anxiety disorders and PTSD are extremely high in children and youth. Following the 1988 Armenian earthquake that killed 25,000 people and left an additional 500,000 homeless, many children in the most affected areas met criteria for both PTSD and a depressive disorder. A significant number also met the diagnostic criteria for separation anxiety disorder. Clearly, depression in such cases may be a secondary disorder arising from bereavement, especially as PTSD can interfere with the grieving process.
Other, possibly subclinical, reactions to disaster in children are known to include anxiety, concerns about safety and security, increased fears that may lead to phobias, and decreased academic functioning. However, it is important to note that for many children treated following a disaster, the child's predisaster levels of functioning may not be known, and it is often difficult to determine whether certain symptoms preceded the disaster or are reactions to trauma.
In this section, we have discussed four stages of children's reactions to disasters and terrorism. These four stages are, the recoil phase, the postimpact phase, the recovery and reconstruction phase, and other reactions.
In the next section, we will discuss three contributing factors in children's reactions to disaster and terrorism. These three contributing factors are aspects of traumatic exposure, preexisting characteristics of the child, and aspects of the recovery environment.
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