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Section 13
Assessing Levels of Posstraumatic Stress in Children

Question 13 | Test | Table of Contents

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In the last section, we 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.

In this section, 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.

The summer bushfire season between 1993 and 1994 in New South Wales, Australia, was the worst on record to that point, with 800 separate bushfires reported over a 20-day period.  About 800,000 hectares of land were burned, including two suburban areas.  Although only four lives were lost, for the children affected by the bushfire, the 20-day period was characterized by uncertainty and continual physical reminders of the fires.  Smoke, ash, haze, and altered visibility were a constant, and wind shifts made it difficult to gauge fire proximity and actual danger. 

Children’s distress was heightened by this uncertainty, as adults had conflicting opinions between whether to defend the family home or leave for a safer location.  Many parents continued to work during the bushfires, and  many children reported being severely concerned for their parent’s welfare.  In addition, media broadcasts exposed children to clear images of the destruction, and many children reported hearing frightening noises, such as emergency vehicle sirens, the sounds of burning vegetation, and trees exploding

Children’s traumatic exposure and perceived life threat was additionally complicated by the fact that many children were evacuated literally minutes before their houses were destroyed.  Some children were not evacuated in time, and survived in houses partially destroyed by the fire.  There were also accounts of last minute parent child separations, with one parent remaining in the house to combat an approaching fire, while the rest of the family evacuated.

Screenings of those elementary school students considered to be the most affected by the bushfires six months after the event found that most students reported trauma-related symptoms.  12% of the sample experienced moderate to severe levels of distress, and only 11.5% reported no symptoms of distress related to the bushfires.  Additionally, 14.1% of the sample reported symptoms consistent with high trait anxiety, and 4.7% reported symptoms consistent with depressive illness. 

3 Methods to Assess Children Ages Six to Eight
Although older elementary school children were assessed using questionnaires, three different methods were used to assess younger elementary school children between the ages of six and eight. 

Method #1 - Yes or No Questions
The first  of these methods was to use yes or no questions, rather than open ended questions. 

Method #2 - Draw Pictures in Response to Neutral Questions
Second, in order to assess persistent posttraumatic pathology, children were asked to draw pictures in response to two neutral questions.  Researchers either asked children:
-- "please draw me a picture,"  or
-- "please draw a picture of one of your dreams." 
In this manner, fire-related response images communicated post traumatic pathology.  However, this assessment style was not useful in a classroom context, as researchers found a strong contagion effect.  If one child drew bushfire related imagery, other children would quickly pick up on the theme.

Method #3 - Describe Kerry’s Feelings
In addition to using yes or no questions, and asking children to draw pictures in response to a neutral question, the third method of assessment researchers used with young elementary school children was the use of a drawing with a young person standing outside an undamaged house, with what appeared to be fire and smoke on a nearby hill.  Since researchers were concerned about asking children direct trauma related questions, researchers instead were presented with the picture, and told that the young person in the picture was named Kerry, which is a gender-neutral name in Australia. 

Children were then asked to describe Kerry’s feelings at that time and quite a long time after the fire.  It was assumed that children would draw on their own experiences, feelings, and cognitions to answer the questions about Kerry.  The exercise was well received, and none of the children in the study became extremely distressed during the vignette exercise.

Close to 75% of the children studied stated that Kerry would not be feeling "normal" during the event.  Common emotions attributed to Kerry during the event were fear and sadness.  Children also reported concerns about separation and loss.  Kerry was said to be afraid that his house would burn down, or that he or she or a parent would die, or go away.  40% of the children reported that Kerry was afraid he or she might be left alone. 

When children were prompted that it was now a long time after the fire, many children persisted in validating trauma-related answers for Kerry.  Over 50% attributed scary dreams and persistent daytime thoughts of the fires to Kerry.  However, 66% of the children agreed that Kerry tried very hard not to think about the fire.    Stomach and sleeping problems, as well as feeling "scared" were also frequently attributed to Kerry, however the number of children reporting Kerry still felt scared decreased significantly.  Additionally, many children felt that Kerry would still be upset if somebody talked about the bushfires.

Some age differences occurred in young elementary children’s responses to the screening methods.  Older children, closer to age 8, were less likely to state that Kerry would feel "normal" during the fires than were younger children.  Older children also were more likely to attribute feelings of being frightened to Kerry.  93% of the 8-year-olds described Kerry as being frightened, as opposed to only 30% of children a year younger.

There were also gender differences observed by researchers in the children’s responses to the screening methods.  Girls were more significantly more likely than boys to state that Kerry thought the fire would occur again, and were more often concerned that the house would burn down.  Girls also more often reported that Kerry would be concerned that his or her mother, father, or self would die in the fire.

Think of a child you may be treating following a natural disaster similar to the 1994 New South Wales bushfires.  How might the screening methods proposed in this study be useful in evaluating his or her posttraumatic stress?

In this section, we have discussed 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.

In the next section, we will continue to discuss a study conducted in 1994 that investigated the impact of a bushfire disaster in New South Wales, Australia.  We will specifically discuss postdisaster coping materials evaluated by the researchers.

Peer-Reviewed Journal Article References:
Gilkey, S. (2010). Review of Treating traumatized children: Risk, resilience and recovery [Review of the book Treating traumatized children: Risk, resilience and recovery, by D. Brom, R. Pat-Horenczyk & J. D. Ford, Eds.]. Traumatology, 16(1), 66–67. 

Grolnick, W. S., Schonfeld, D. J., Schreiber, M., Cohen, J., Cole, V., Jaycox, L., Lochman, J., Pfefferbaum, B., Ruggiero, K., Wells, K., Wong, M., & Zatzick, D. (2018). Improving adjustment and resilience in children following a disaster: Addressing research challenges. American Psychologist, 73(3), 215–229.

Kilmer, R. P., Gil-Rivas, V., & Roof, K. A. (2020). Associations between children’s self-system functioning and depressive and posttraumatic stress symptoms following disaster. American Journal of Orthopsychiatry. Advance online publication. 

QUESTION 13
What were three methods researchers used to assess levels of posttraumatic stress in young elementary school children? To select and enter your answer go to Test.


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