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Children’s Disaster Reactions: the Influence of Exposure and Personal Characteristics



This paper reviews children's reactions to disasters and the personal and situational factors that influence their reactions. Posttraumatic stress disorder (PTSD) and posttraumatic stress reactions are the most commonly studied outcomes, though other conditions also occur including anxiety, depression, behavior problems, and substance use. More recently, traumatic grief and posttraumatic growth have been explored. New research has delineated trajectories of children's posttraumatic stress reactions and offered insight into the long-term consequences of their disaster experiences. Risk factors for adverse outcomes include pre-disaster vulnerabilities, perception of threat, and loss and life disruptions post-disaster. Areas in need of additional research include studies on the timing and course of depression and anxiety post-event and their interactions with other disorders, disaster-related functional and cognitive impairment, positive outcomes, and coping.
Childrens Disaster Reactions: the Influence of Exposure
and Personal Characteristics
Betty Pfefferbaum
&Anne K. Jacobs
&Natalie Griffin
&J. Brian Houston
#Springer Science+Business Media New York 2015
Abstract This paper reviews childrens reactions to disasters
and the personal and situational factors that influence their
reactions. Posttraumatic stress disorder (PTSD) and posttrau-
matic stress reactions are the most commonly studied out-
comes, though other conditions also occur including anxiety,
depression, behavior problems, and substance use. More re-
cently, traumatic grief and posttraumatic growth have been
explored. New research has delineated trajectories of chil-
drens posttraumatic stress reactions and offered insight into
the long-term consequences of their disaster experiences. Risk
factors for adverse outcomes include pre-disaster vulnerabil-
ities, perception of threat, and loss and life disruptions post-
disaster. Areas in need of additional research include studies
on the timing and course of depression and anxiety post-event
and their interactions with other disorders, disaster-related
functional and cognitive impairment, positive outcomes, and
Keywords Adolescents .Anxiety .Children .Coping .
Depression .Disaster .Exposure .Mental health .
Posttraumatic growth .Posttraumatic stress .Posttraumatic
stress disorder (PTSD) .Recovery .Resilience .Terr o r ism .
Trauma .Traumatic grief
Children have been recognized as especially vulnerable to
disasters [1]. A nationally representative survey conducted in
the USA established a lifetime rate of disaster exposure at
13.9 % in children and adolescents [2]; almost one fourth of
those who experienced a lifetime disaster reported more than
one disaster. In another nationally representative US survey of
adolescents, exposure to natural or human-caused disasters
was 14.8 %, second only to unexpected death of a loved one
at 28.2 % as the most common potentially traumatic event [3].
Rates in other parts of the world, especially in less developed
regions, are likely to be higher due to less durable infrastruc-
tures, rapid expansion of populations and industrialization,
and political conflict.
This paper reviews childrens emotional and behavioral
reactions to disasters with a focus on recent studies that have
explored an expanded range of outcomes, trajectories of re-
sponse and long-term disaster effects, and nuances of expo-
sure and childrens personal characteristics that affect their
recovery. A companion paper reviews the environmental in-
fluences, such as family and community factors, on childrens
reactions [4••].
This article is part of the Topical Collection on Child and Family Disaster
*Betty Pfefferbaum
Anne K. Jacobs
Natalie Griffin
J. Brian Houston
Department of Psychiatry and Behavioral Sciences, College of
Medicine, University of Oklahoma Health Sciences Center,
P.O. Box 26901, WP3217, Oklahoma City, OK 73126-0901, USA
Terrorism and Disaster Center, University of Oklahoma Health
Sciences Center, P.O. Box 26901, WP3217, Oklahoma
City, OK 73126-0901, USA
Department of Communication, University of Missouri, 115 Switzler
Hall, Columbia, MO 65211-2310, USA
Curr Psychiatry Rep (2015) 17:56
DOI 10.1007/s11920-015-0598-5
Childrens Reactions to Disasters
The literature describes a range of disaster outcomes in
children from transient emotional distress and behavior
changes to enduring psychopathology and impaired func-
tioning [5,6]. Many children, while experiencing distress
in association with their disaster experiences, do not de-
velop psychopathology, but instead adapt to their experi-
ences and environment. Commonly studied post-disaster
outcomes are internalizing reactions and conditions such
as posttraumatic stress disorder (PTSD) and posttraumatic
stress reactions, anxiety, and depression. Externalizing be-
havior problems including substance use, cognitive ef-
fects, and traumatic grief have also been investigated.
Some children are resilient, and some experience posttrau-
matic growth. Recent studies have illustrated the trajecto-
ry of childrens reactions over time, but few long-term
follow-up studies have been conducted.
Rates of PTSD and posttraumatic stress in children post-
disaster vary depending on the samples assessed, the specific
outcomes measured, and the research methodology used. For
example, rates of significantly elevated symptom severity
have been estimated to be below 30 % [7], and the rate of
moderate posttraumatic stress symptoms in the acute post-
disaster period has been estimated at 50 % [6]. A recent
meta-analysis of studies of children and adolescents from
countries around the world revealed that overall, 15.9 % of
youth exposed to a traumatic event developed PTSD,
which reflects 9.7 % of children exposed to non-
interpersonal trauma, such as accidents and natural disas-
ters, and 25.2 % of youth exposed to interpersonal trauma
[8]. Posttraumatic stress symptoms appear to be common
in the first months post-event with a decline over the first
year or longer [7].
Depression and anxiety are common reactions to disas-
ters often comorbid with PTSD or posttraumatic stress [7,
9]. Depression may occur secondary to loss and grief, un-
resolved trauma and posttraumatic stress, and/or secondary
adversities [9]. Depression also may precede posttraumatic
stress symptoms [10]. Lai and colleagues [10]foundco-
morbid posttraumatic stress and depression in their hurri-
cane study in which loss of life was relatively low with 10
and 7 % of children evidencing comorbid posttraumatic
stress and depression symptoms 8 and 15 months post-di-
saster, respectively; recovery was slower in those with co-
morbid posttraumatic stress and depression. A recent re-
view study reported elevated prevalence rates for post-
disaster depression ranging from 2 to 69 % in children
relative to cited general populationratesfrom1to9%
[11••]. Another review of depression in children after nat-
ural disasters revealed prevalence rates in children ranging
from 7.5 to 44.8 % across studies [12]. Given these high
rates, more empirical work is warranted to explore the
varied etiologies and time course of depression as well as
its relationship to other disorders.
Disaster exposure may initiate a path to the develop-
ment of anxiety disorders such as specific phobias, panic
disorder, and separation anxiety [6]. Studies have docu-
mented increases in childrens generalized anxiety in re-
lation to disaster exposure [7], but post-disaster anxiety
may represent the continuation of pre-event anxiety or
trait anxiety [13]. Not all longitudinal studies have con-
firmed an increase in anxiety symptoms post-event,
though this may simply reflect an absence of the normal
decline in rates over the course of development [14].
Thus, additional work is needed to clarify findings relat-
ed to post-disaster anxiety in children, to identify predis-
posing influences, and to explore the progression of anx-
iety symptomatology and its relationship to other disaster
Behavior problems also have been studied in children in
the context of disasters with conflicting results. For example,
research has documented both an increase in externalizing
conditions [e.g., 15,16] and improvement in childrensbehav-
ior post-event with a return to pre-event levels over time [e.g.,
17,18]. Recent work in the Middle East suggests that expo-
sure to chronic terrorism and political violence is linked to
behavior problems [e.g., 19]. For example, Pat-Horenczyk
and colleagues [19] found that preschool children exposed to
ongoing political violence had higher rates of behavior prob-
lems as well as PTSD and depression symptoms than children
without chronic exposure. Moreover, maternal distress was
associated with child distress in the form of externalizing,
internalizing, and posttraumatic stress symptoms, and the ac-
cumulated and continuous exposure to political violence and
danger increased maternal distress which further affected the
child [19].
Recent literature has examined substance use in association
with disaster exposure in youth [e.g., 2024]. In a sample of
New York City high school students assessed 6 months after
the September 11 attacks, increased smoking was associated
with prior trauma and PTSD while increased drinking was
associated with direct exposure to the attacks [24]. A longitu-
dinal study of adolescents assessed 5 months following a
deadly café fire in the Netherlands revealed that students in
the affected school had significantly greater increases in ex-
cessive drinking than students in unaffected schools [22].
Twelve months later, increases in excessive use of alcohol
from baseline to follow-up also were significantly greater in
students from the affected school than in the comparison
group but the effects had decreased compared to those at
5 months, and there were no differences between the two
groups in behavioral and emotional problems or in the use
of other substances [23]. Long-term follow-up studies also
suggest that problem alcohol [25] and problem substance
[26] use may not persist in disaster samples.
56 Page 2 of 6 Curr Psychiatry Rep (2015) 17:56
Functioning and Cognitive Impairment
While the importance of addressing childrens post-disaster
functioning in general has been recognized for some time,
little research has focused on cognitive effects or on the rela-
tionship between functioning and other post-disaster prob-
lems. Impairment in childrens functioning post-disaster may
be most evident in school where they are required to perform
both academically and socially, sometimes in altered environ-
ments with damaged school facilities and disruptions in sched-
ules and routines. Scrimin and colleagues found difficulties in
attention, memory [27,28], and visual-spatial performance as
well as lower grades [28] in children exposed to the Beslan
school hostage crisis. In a study examining six domains of
school and interpersonal functioning in relationship to alcohol
and drug use in middle and high school students attending
schools near the World Trade Center at the time of the Sep-
tember 11 attacks, students with increased substance use ex-
perienced more impairment in school work and school behav-
ior compared to those without increased substance use
18 months post-incident [20].
Grief, Complicated Grief, and Traumatic Grief
Children who lose loved ones in a disaster suffer grief which
may be exacerbated in the context of the familyssocialand
economic adversities such as financial problems and lack of
housing [29]. Some children suffer complicated griefthe per-
sistence of acute grief or the development of complications in
the context of the grief process [30]and/or traumatic grief
the intrusion of trauma symptoms into the bereavement pro-
cess [31]in relationship to their loss. Little empirical re-
search has addressed these grief reactions. Dyregrov and col-
leagues [32] found a high prevalence of complicated grief,
posttraumatic stress reactions, and general psychological dis-
tress in parents and siblings 1.5 years after a 2011 terrorist
attack on a youth camp in Norway that killed 69 youth and
adults. Intense contemporaneous exposure through telephone
or text messaging with the victims as the event unfolded, ex-
tensive media coverage, and the previously peaceful context of
the environment were thought to influence reactions [32].
Posttraumatic Growth
Posttraumatic growth includes psychological (e.g., greater ap-
preciation for life, modified values, increased sense of person-
al strength), interpersonal (e.g., improved relationships), and/
or functional (e.g., ways of coping) gains that were not appar-
ent pre-disaster but arose from the disaster experience [33,
34]. Posttraumatic growth and distress are not two ends on a
spectrum, and they may co-occur [35]. The traumatic circum-
stances that cause distress can also mobilize the coping at-
tempts and adaptation that result in growth. For example,
posttraumatic stress predicted posttraumatic growth in a study
of children from the Gulf Coast 1 year after Hurricane Katrina,
demonstrating that distress may spark growth [36].
Trajectories of Response and Long-Term Recovery
Recent research examining trajectories of childrensdisaster
reactions has identified adaptive and maladaptive outcomes
[13,37,38••]. For example, La Greca and colleagues [13]
identified three trajectories of posttraumatic stress symptoms
in children during the first year (3, 7, and 10 months) after
Hurricane Andrew. Approximately 20 % of the sample had a
chronic course, 43 % of the sample was characterized as re-
covering, and 37 % of the sample was described as resilient.
Mean posttraumatic stress symptom scores decreased signifi-
cantly over time in all three trajectories. Removing children
with minimal exposure in recalculating their findings, Weems
and Graham [38••] found the proportion of resilient children
in their sample dropped from 43 % to only 16 %, highlighting
the importance of considering exposure in determining resil-
ience. La Greca and colleagues [13] found that childrens
disaster exposureboth perceived and actual threatdid
not distinguish the recovering and chronic trajectories from
the resilient trajectory, but that children who reported per-
ceived life threat and/or more loss and disruption were more
likely to fit in the recovering or chronic trajectories rather than
the resilient trajectory.
Long-term follow-up studies suggest recovery for most
children following disasters. In a 20-year follow-up study,
McFarlane and Van Hooff [25] reported no significant differ-
ence in PTSD rates in Australian children exposed to a mas-
sive bushfire relative to a non-exposed comparison group, and
the risk of developing an anxiety disorder was small relative to
the controls except in those exposed to multiple traumas. Mor-
gan and colleagues [26] reported that 29 % of the child survi-
vors of a deadly 1966 coal pile collapse had current PTSD
33 years after the disaster though the comparison group from a
village nearby in the same economically depressed area of the
country also had high rates of psychopathology. Survivors
were at no greater risk for developing anxiety, depression, or
substance use than controls [26].
The Influence of Exposure on Childrens Disaster
The extant research supports a dose-response relationship be-
tween disaster exposure and outcomes, with the severity of
outcomes associated with the intensity or severity of expo-
sures [39,40••]. In their meta-analysis of 96 child disaster
studies, Furr and colleagues [39] concluded that it is not mere
proximity to an event but specific aspects of exposure that
Curr Psychiatry Rep (2015) 17:56 Page 3 of 6 56
determine risk for adverse outcomes. For example, the childs
perception of threat and other subjective reactions; the extent
of disruption, destruction, injury, and death; and the childs
specific disaster experiences such as being injured, witnessing
the event, and loss of loved ones are aspects of disaster expo-
sure that influence posttraumatic stress [39] and depression
[11••,12]. The dose-response relationship applies to interper-
sonal disaster exposure through, for example, the closeness of
family and associates [41].
The Influence of Personal Factors on Childrens
Disaster Reactions
A number of child characteristics affect childrens disaster
reactions and recovery including demographics, preexisting
vulnerabilities, and post-disaster experiences. Girls are com-
monly identified as being at greater risk than boys for adverse
outcomes such as posttraumatic stress reactions [39] and de-
pression [11••], but it may be that boys and girls display dis-
tress differently with girls suffering more internalizing symp-
toms and boys evidencing more externalizing difficulties.
Moreover, boys and girls may interpret and report events dif-
ferently [40••]. Childrens age or stage of development influ-
ences their understanding of an event, the specific presentation
of their reactions [42], and adaptation [40••], but findings on
the effects of age or development on outcomes are inconclu-
sive [40••]. Children of ethnic minority heritage may be at
greater risk for adjustment problems post-disaster than chil-
dren from the majority culture, but these differences may rep-
resent, or be influenced by, differences in disaster experiences,
socioeconomic status, exposure to prior trauma, and/or family
or other social influences [6]. Childrens pre-event emotional
status, prior trauma, and major life events post-incident influ-
ence their disaster reactions and recovery [6,11••,12,40••].
Coping entails both involuntary and deliberate cognitive, be-
havioral, and emotional efforts to reconcile a perceived dis-
crepancy between the demands of environmental stressors and
the childs own personal resources [43]. Coping strategies can
be adaptive or maladaptive depending on their relationship to
adverse outcomes [44••]. Childrens ability to cope, their ap-
proach to coping, and their repertoire for coping vary with age
and development [44••,45], gender [45], and culture [e.g.,
46]. Other factors that may influence coping include aspects of
the childs event exposure [e.g., 47,48] or the interaction of
personal and exposure characteristics [e.g., 49], time since the
disaster [e.g., 50], the degree of perceived control the child has
over the situation [e.g., 51], and the childs disposition [45]
and self-esteem [e.g., 52]. The literature in general approaches
mass trauma as single incidents, though coping has been ex-
plored in the context of ongoing political violence [44••]. Lit-
tle disaster research has explored coping in relationship to
positive outcomes such as well-being [44••].
Conclusions and Future Directions
An impressive literature over several decades has documented
childrens reactions to disasters and the various event, exposure,
and personal factors that influence those reactions. Recent re-
search has extended the examination of outcomes beyond in-
ternalizing conditions (e.g., PTSD, anxiety, depression) to in-
clude externalizing conditions (e.g., behavior problems, sub-
stance use), functioning and cognitive impairment, traumatic
grief, and posttraumatic growth. With a primary focus on PTSD
and posttraumatic stress reactions, relatively little is known
about pre- and post-event comorbid conditions that may affect
outcome [13]. Longitudinal assessment of children has charted
childrens reactions over several years post-disaster and delin-
eated trajectories of response. Many children exposed to disas-
ters are resilient. Studies suggest that in addition to aspects of
disaster exposure such as perceived life threat, preexisting child
characteristics and pre- and post-event life experiences are im-
portant determinants of the childs disaster outcomes. The liter-
ature has begun to address childrens coping in the context of
disasters, but the studies are too few and too diverse to draw
definitive conclusions about the strategies and determinants that
influence outcomes. Additional research to benefit the field
would include exploring the timing and course of depression
and anxiety post-event and their interactions with other disor-
ders and the effects of disasters on childrens quality of life and
potential growth as well as on psychopathology.
Acknowledgments This work was conducted by the Terrorism and
Disaster Center (TDC), at the University of Missouri and the University
of Oklahoma Health Sciences Center, a partner in the National Child
Traumatic Stress Network (NCTSN). TDC is funded by the Substance
Abuse and Mental Health Services Administration (SAMHSA), U.S.
Department of Health and Human Services (HHS). Points of view in this
document are those of the authors and do not necessarily represent the
official position of HHS, NCTSN, SAMHSA, the University of Missouri,
or the University of Oklahoma Health Sciences Center.
Compliance with Ethics Guidelines
Conflict of Interest Natalie Griffin and J. Brian Houston declare that
they have no conflict of interest.
Betty Pfefferbaum has received a grant from the Substance Abuse and
Mental Services Administration.
Anne K. Jacobs has received consulting fees/honorarium from the
University of Oklahoma Health Sciences Center and the University of
Missouri, Columbia, MO.
Human and Animal Rights and Informed Consent This article does
not contain any studies with human or animal subjects performed by any
of the authors.
56 Page 4 of 6 Curr Psychiatry Rep (2015) 17:56
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... To date, the bulk of research available on community resilience has been conducted in 'silos' and in the context of natural disasters (e.g., responses to floods, hurricanes, tsunami), public health (e.g., pandemics) and public safety concerns (e.g., terrorist attacks), with little attention and research on community resilience in the face of homelessness (see, for example, Adger, 2000;Chandra et al., 2013;Cutter et al., 2008;Herrmann-Lunecke & Villagra, 2020;Imperiale & Vanclay, 2016;Luthar & Cicchetti, 2000;Masten, 2001;Pfefferbaum et al., 2015;Rapaport et al., 2018). Yet, as many researchers have convincingly shown, homelessness should be treated and responded to as a disaster (Doll et al., 2022;Karabanow et al., 2022). ...
... The largest body of research available on community resilience has explored, operationalized, and studied the concept through disaster emergency management (Imperiale & Vanclay, 2016;Pfefferbaum et al., 2015;Rapaport et al., 2018). As much of this research was outside the purview of our interest in community resilience in the face of homelessness, we provide a brief overview of the existing research, recognizing that much more has been written about community resilience from a structural response framework. ...
... In contrast, few participants in our sample endorsed exposure to warfare (3.0%) or to natural disaster (4.3%) in childhood, and the probabilities of these items were not well differentiated between the three classes. Considering studies that linked exposure to warfare and natural disaster to negative mental health outcomes (Kadir et al., 2019;Pfefferbaum et al., 2015), more research is needed to examine these specific ELS in affected geographical locations. ...
... Despite the high association between psychotic symptoms and dementia, there is still a gap in the differential diagnosis between primary and cognition-related conditions 51 . Approximately 60% of patients with late-onset psychotic symptoms have secondary psychosis, and a thorough medical evaluation is extremely important 52 . ...
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Unlabelled: The frequency of psychotic symptoms in older adults is high, mainly in neurocognitive cognitions of the most varied etiologies. Objectives: This study aimed to review the studies that analyze the frequency of the types of delusions, hallucinations, and misidentifications in dementia conditions of different etiologies. Methods: A systematic review was conducted on August 9, 2021, in the PubMed, PsycInfo, Embase, Web of Science, and Scopus databases with the following descriptors: (dementia OR alzheimer disease OR dementia with Lewy bodies OR frontotemporal dementia OR mixed dementia OR vascular dementia OR major neurocognitive disorder OR parkinson disease dementia) AND (psychotic symptoms OR psychosis OR hallucinations OR delusions OR psychopathology OR misidentification) AND (prevalence OR epidemiology). Results: A total of 5,077 articles were found, with a final inclusion of 35. The overall frequency of psychotic symptoms ranged from 34 to 63% in dementia conditions of the most varied etiologies. Alzheimer's disease (AD) presents more delusions and hallucinations and has a higher frequency regarding the presence of misidentifications. On the contrary, Dementia with Lewy bodies (DLB) seems to present more hallucinations, even auditory, when compared to the other dementias, concomitantly with delusions. Vascular and frontotemporal dementia present fewer psychotic symptoms than DLB and AD. Conclusions: We identified a gap in the literature on the description of the psychotic symptoms of dementia, mainly in those of non-AD etiologies. Studies that assess the neuropsychiatric symptoms of dementias deeply might contribute in a more definite manner to the causal diagnosis of dementia.
... Likewise, in a nation-wide telepsychiatry study conducted in our country, it was documented that the most common reason for families to apply to child mental health professionals was to counseling on telling children about the pandemic/ parenting support (Dursun et al. 2021). Several reports have shown that both children and adults exposed to disasters may experience a range of mental health problems (Anjum et al. 2020, Furr et al. 2010, Pfefferbaum et al. 2015) especially internalizing and externalizing problems which are found to be prevalent in disaster-exposed children (Felix et al. 2011, Lai et al. 2013, Lowe et al. 2013, Scaramella et al. 2008). However, studies on the needs of these two populations . ...
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Background: Investigating the outpatient clinic admissions of children and adolescents significantly affected by the pandemic is crucial in developing policy and intervention methods in the future. The aim of this study is to analyze the admissions of child and adolescent psychiatry outpatient clinics, during the first year since the imposed rearrangements of the COVID-19 pandemic, compared to the one year before. Subjects and methods: This study was conducted between March 2019 and March 2021 and the total number of 5833 patients referred to the hospital was 3168 in the pre-pandemic period (Pre-P) and 2665 in the pandemic (In-P) period. After excluding 78 not fulfilling inclusion criteria, these screened cases were randomized for 700 patients for Pre-P and 700 for In-P within each group. Results: Externalization Disorders and Neurodevelopmental Disorders were the most represented diagnoses categories between the two time periods and showed a statistically significant decrease in admission during the pandemic (p=0.002, p=0.024, respectively). Internalization disorders and the undiagnosed group showed a statistically significant increase during the pandemic (p=0.024, p<0.001, respectively). Significant differences were also shown in the treatment plan (need for pharmacological and psychotherapy) has increased. Conclusions: This study stands out by providing data on the trend of diagnosis in a child and adolescent psychiatry outpatient clinic before and during the pandemic period. To dominate these trends would be important to provide a basis for policymakers to plan appropriate management methods and levels of support for children and adolescents with different mental disorders.
... 20.52% of the youth population after suffering from injury developed PTSD (2), and the overall lifetime prevalence is 3-9% (3). Prior findings have suggested that children and adolescents are more vulnerable to developing PTSD after catastrophic events than are adults (4,5). As a collective trauma caused by natural disasters, earthquakes have caused more extensive trauma to the public representing the negative impact on social processes at the collective level compared to individual crisis events (6). ...
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For children and adolescents, there is a high risk of developing post-traumatic stress disorder (PTSD) after suffering from catastrophic events. Previous studies have identified brain functionally and subcortical brain volumes structurally abnormalities in this population. However, up till now, researches exploring alterations of regional cortical thickness (CTh) and brain interregional structural covariance networks (SCNs) are scarce. In this cross-sectional study, CTh measures are derived from 3-Tesla Tl-weighted MRI imaging data in a well-characterized combined group of children and adolescents with PTSD after an earthquake (N = 35) and a traumatized healthy control group (N = 24). By using surface-based morphometry (SBM) techniques, the regional CTh analysis was conducted. To map interregional SCNs derived from CTh, twenty-five altered brain regions reported in the PTSD population were selected as seeds. Whole-brain SBM analysis discovered a significant thickness reduction in the left medial orbitofrontal cortex for the subjects with PTSD. Similarly, analysis of SCNs associated with “seed” regions primarily located in default mode network (DMN), midline cortex structures, motor cortex, auditory association cortex, limbic system, and visual cortex demonstrated that children and adolescents with PTSD are associated with altered structural covariance with six key regions. This study provides evidence for distinct CTh correlates of PTSD that are present across children and adolescents, suggesting that brain cortical abnormalities related to trauma exposure are present in this population, probably by driving specific symptom clusters associated with disrupted extinction recall mechanisms for fear, episodic memory network and visuospatial attention.
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Introduction: Natural hazards are damaging environmental events, such as fires, droughts and floods, which have negative impacts on human lives, livelihoods and health. Natural hazards are increasing in intensity and severity, and may potentially have harmful effects on the health and development of children who experience them. There are few syntheses of the evidence about the effects of natural hazards on the early development of children aged from birth to 5 years old. The aim of this systematic review and meta-analysis is to determine the impact of natural hazards on the cognitive, motor, language, social and emotional development of children from birth to 5 years old. Methods and analysis: Comprehensive searches will be conducted in five bibliographic databases: Ovid MEDLINE, Ovid PsycInfo, CINAHL Plus, Scopus and Ovid EMBASE, using predefined search terms to identify the relevant studies. The review will follow the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies will be included if they report on the association between exposure to natural hazards and at least one indicator of early childhood development (ECD). Extracted data will include: main study findings, characteristics of the study design, measures of natural hazards and ECD indicators. Observational studies with cross-sectional, case–control, prospective or retrospective cohort designs will be included in this review. Case descriptions and qualitative studies will be excluded. Study quality will be assessed using the Joanna Brigg’s Institute critical appraisal tools. We will conduct a meta-analysis if the reviewed studies are sufficiently homogeneous according to research design, exposure, participants and outcome measures. The meta-analysis will include subgroup analyses (eg, length of exposure to natural hazard, type of natural hazard, ECD indicator). Ethics and dissemination: The findings will be disseminated through a peer-review publication, policy brief, technical report and report published on institutional stakeholder websites. PROSPERO registration number: CRD42022331621.
This article reports on effects of two earthquakes in Mexico on adolescents attending middle school. The earthquakes struck in close succession during the implementation of a school-based prevention program, providing an opportunity to assess emotional distress due to the earthquakes and whether the life skills taught in the program affected how students coped with the natural disaster. The objectives were to (1) evaluate the earthquakes' impact on students' distress; (2) assess if distress is associated with internalizing symptomology and externalizing behaviors; and (3) investigate if students receiving the original and adapted versions of the intervention coped better with the events. A Mexico-US research team culturally adapted keepin' it REAL to address connections between substance use among early adolescents in Mexico and exposure to violence. A random sample of public middle schools from three cities (Mexico City, Guadalajara, and Monterrey), stratified by whether they held morning or afternoon sessions, was selected. A total of 5522 7th grade students from 36 schools participated in the study. Students answered pretest and posttest questionnaires; the latter assessed earthquake-related distress and coping strategies. Earthquake-related distress was associated with all measures of undesired internalizing symptomology and externalizing behaviors. Compared to controls, students in the adapted intervention reported less aggressive and rule-breaking externalizing behavior and less violence perpetration. However, these intervention effects were not moderated by the level of earthquake-related distress, and they were not mediated by positive or negative coping. The findings have implications for prevention intervention research and policy as natural and human-made disasters occur more often.
In the past 20 years, climate-induced disasters have significantly increased in severity and frequency. Disasters can cause catastrophic damage, destroying homes and displacing individuals, families, and communities, often evoking psychological distress among survivors. Children and youth are among the most vulnerable during and after a disaster with risk and protective factors playing an important role in post-disaster adaptation. Risk factors that increase the likelihood of short- and long-term distress include higher level of disaster exposure, pre-existing mental health challenges, maladaptive coping, and family conflict. Conversely, protective factors such as social connection, healthy family relationships, self-efficacy, and positive coping reduce the likelihood of post-disaster distress. Evidence-based prevention and treatment interventions can also play an important role in helping children and youth recover after a disaster. Effective post-disaster interventions include activities that aim to increase emotional and behavioral regulation, adaptive coping skills, and peer and caregiver connections. It is well documented that interventions can aid in a young person’s recovery. However, limited funding and challenges with participant recruitment and retention are inherent in post-disaster service delivery and research.KeywordsRisk and protective factorsEvidence-based interventionsDisaster mental healthChildrenDisaster recoveryPost-disasterJourney of Hope
The Coronavirus (Covid-19) pandemic is a global health crisis which has resulted in mass disruption to daily life, extended school closures and quarantine measures. Research suggests that the pandemic is likely to negatively impact children’s mental health. Therefore, it is imperative to understand how to support children returning to school following Covid-19. The aim of this systematic review was to analyse existing empirical research focusing on methods of supporting children following a crisis to identify the most effective school-based supports in response to the Covid-19 pandemic. Six databases were searched which initially identified 4301 articles. Through an iterative process, 18 articles were identified which met the inclusion criteria for review. This review highlighted the ecological nature of school-supports, with schools providing support to children across various levels such as direct support in the classroom in addition to indirect whole-school and community approaches. The role teachers play in supporting children’s wellbeing post-crisis through responsive teaching was also identified. Furthermore, results showed the effectiveness of universal strengths-based interventions to promote resilience and the role of peer support in enhancing children’s wellbeing. At a systemic level, findings also highlighted the importance of community-based school supports such as communication with families, the promotion of staff wellbeing and professional collaboration. Overall, this review identifies schools’ capacity to support children at various levels post-crisis. It also highlights the potential role of educational psychologists when children return to school post-Covid-19, whilst also establishing the need for more research on children’s mental health following Covid-19.
Child life specialists have been supporting children and families in disaster relief settings for years. It is imperative to understand the needs of children affected by disasters and continue to integrate child life services to best support the psychological and emotional outcomes of children and families. This chapter will define disasters and the disaster management cycle, overview key factors in assessing children's needs related to disasters, identify how child life services are utilized during each phase of disaster relief, and identify future opportunities for child life services in disaster relief.
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This review examines family (demographics, parent reactions and interactions, and parenting style) and social (remote effects, disaster media coverage, exposure to secondary adversities, and social support) factors that influence children's disaster reactions. Lower family socioeconomic status, high parental stress, poor parental coping, contact with media coverage, and exposure to secondary adversities have been associated with adverse outcomes. Social support may provide protection to children in the post-disaster environment though more research is needed to clarify the effects of certain forms of social support. The interaction of the factors described in this review with culture needs further exploration.
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The goal of this paper was to critically evaluate the literature on children coping with mass trauma published between the years 2011 and 2014 and to emphasize interesting and important findings with the aim of proposing a new comprehensive model for better understanding the process of coping with these events in this unique developmental stage. Using a variety of databases, 26 research papers were selected. The papers were divided into two main categories, natural and manmade disasters. The findings suggest that several areas in this context still lack foundational knowledge and should be further investigated. Thus, it has been suggested that future research should emphasize the developmental stage of the children, the cultural context and atmosphere in which the investigated children grow up and live, and the type of event (acute vs. chronic; natural vs. manmade). A more comprehensive coping model which addresses these omissions and combines main theories is suggested for use in future research as well.
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Disasters typically strike quickly and cause great harm. Unfortunately, because of the spontaneous and chaotic nature of disasters, the psychological consequences have proved exceedingly difficult to assess. Published reports have often overestimated a disaster's psychological cost to survivors, suggesting, for example, that many if not most survivors will develop posttraumatic stress disorder (PTSD); at the same time, these reports have underestimated the scope of the disaster's broader impact in other domains. We argue that such ambiguities can be attributed to methodological limitations. When we focus on only the most scientifically sound research-studies that use prospective designs or include multivariate analyses of predictor and outcome measures-relatively clear conclusions about the psychological parameters of disasters emerge. We summarize the major aspects of these conclusions in five key points and close with a brief review of possible implications these points suggest for disaster intervention.
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In a representative sample of 2,030 U.S. children aged 2-17, 13.9% report lifetime exposure to disaster, and 4.1% report experiencing a disaster in the past year. Disaster exposure was associated with some forms of victimization and adversity. Victimization was associated with depression among 2- to 9-year-old disaster survivors, and with depression and aggression among 10- to 17-year-old disaster survivors. Children exposed to either victimization only or both disaster and victimization had worse mental health compared to those who experienced neither. More research into the prevalence and effects of disasters and other stressful events among children is needed to better understand the interactive risks for and effects of multiple forms of trauma.
Children who have had someone close die as a result of a mass trauma event such as war, armed conflict, acts of terror, political violence, torture, mass accidents, and natural disasters are at risk for biopsychosocial problems. Research on how to classify when grief becomes complicated or traumatic in children is scarce, and while functioning level may provide a good indication, assessing functioning may be difficult in mass trauma environments where routines and structure are often lacking. There are promising trauma- and grief-focused interventions for children post-mass trauma, which are mostly provided in school settings. However, more advanced multi-method interventions are needed that address grief and trauma in the context of the child's overall mental health, parent/caregiver role in assisting the child, family system issues, ways to provide safe caring environments amidst chaos and change, and interventions that take into account local consumer perspectives, including the voices of children.
Background: Disasters are destructive, potentially traumatic events that affect millions of youth each year. Objective: The purpose of this paper was to review the literature on depressive symptoms among youth after disasters. Specifically, we examined the prevalence of depression, risk factors associated with depressive symptoms, and theories utilized in this research area. Methods: We searched MEDLINE, PsycInfo, and PubMed electronic databases for English language articles published up to May 1, 2013. Reference lists from included studies were reviewed to capture additional studies. Only quantitative, peer reviewed studies, conducted with youth under the age of 18 years, that examined postdisaster depressive symptoms were included. Seventy-two studies met inclusion criteria. Prevalence of depressive symptoms, disaster type, correlates of depressive symptoms, and theories of depressive symptoms were reviewed. Results: Only 27 studies (38%) reported on prevalence rates among youth in their sample. Prevalence rates of depression among youth postdisaster ranged from 2% to 69%. Potential risk factors were identified (e.g., female gender, exposure stressors, posttraumatic stress symptoms). Theories were examined in less than one-third of studies (k = 21). Conclusions: Given the variability in prevalence rates, difficulty identifying a single profile of youth at risk for developing depressive symptoms, and lack of a unifying theory emerging from the studies, recommendations for future research are discussed. Use of established batteries of assessments could enable comparisons across studies. Merging existing theories from children's postdisaster and depression literatures could aid in the identification of risk factors and causal pathways.
Children’s exposure to political violence has been found to be associated with posttraumatic symptoms and emotional and behavioral problems. However, little distinction has been made between the impact of exposure to continuous political violence and exposure to past political violence. This study in Israel compared a sample of preschool children and mothers (N = 85) with ongoing and recurring exposure to missile and rocket attacks (“Continuous sample”) to a sample (N = 177) from a recent time-limited war (“Past sample”). Mothers completed self-report questionnaires, including exposure to both political violence and other traumatic events, the Posttraumatic Diagnostic Scale (PDS), and a Depression Scale (CES-D). Mothers also reported on the child’s exposure to political violence and other traumatic events, posttraumatic symptoms, and the Child Behavior Checklist (CBCL). The results indicate the severe consequences of living in the face of ongoing traumatic stress. Children and mothers from the continuous exposure sample had more posttraumatic distress and their children had higher behavior problem scores compared with those in the past exposure sample, supporting the allostatic load hypothesis that cumulative stress exacts a heavier toll. Because the mother–child relationship is challenged in situations of exposure to violence, we compared relational trauma (measured by co-occurrence of posttraumatic distress in both mother and child) and found, as hypothesized, that relational trauma was more prevalent in the Continuous sample than in the Past sample. (PsycINFO Database Record (c) 2013 APA, all rights reserved)