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Children in Disasters
... Thus, they need their caregivers to help them regulate their emotions, validating their feelings and helping them feel loved and safe (Bartlett et al., 2020). Through this support and internal resources, children can develop new skills to deal with future adversities (Schonfeld & Gurwitch, 2012). ...
Considering the repercussions of the current public health emergency caused by the coronavirus (COVID-19), it is necessary to understand how children are impacted by their mental health and the strategies that can be adopted while facing this experience.
The individual’s systemic view, which emphasizes his or her relations and interactions, allows a unique deepening of this matter. Thus, the purpose of this article was to present a critical literature review about the impacts of the new coronavirus pandemic on children’s mental health. These impacts can be experienced by the child directly or indirectly and exist in different levels, such as individual, family, and social. Challenges and possibilities for children’s mental health care are discussed regarding pandemic’s impact.
... This positive outlook allows for strong social support systems consisting of caregivers/adults to model positive coping mechanisms with stressful experiences (Vogel & Vernberg, 1993). Consequently, adolescents model the positive learned behavior and build upon their self-efficacy and self-esteem to be more resilient (Prinstein, La Greca, Vernberg, & Silverman, 1996;Schonfeld & Gurwitch, 2012). ...
Many barriers impact the utilization of mental health services among adolescents who survive natural disasters. Although stigma has been identified as one of these barriers, minimal work examines the etiological factors that impact stigma and how these factors operate in perpetuating stigma among adolescents after a disaster. Understanding the role that stigma plays is a critical step to raising awareness of the cognitive and behavioral processes that preserve adolescent’s well-being, timely attainment of developmental milestones, and the potential for engagement in meaningful opportunities. We modify an existing adolescent self-stigma model to better understand how youth might respond psychologically to natural disasters both immediately after the event as well as during the long-term recovery phase. Future empirical research should assess the validity of these barriers within the suggested temporal framework. If this proposed conceptual piece is validated, interventions could be designed that directly address the role of stigma.
Disasters have the potential to cause short- and long-term effects on the psychological functioning, emotional adjustment, health, and developmental trajectory of children, especially if exposure is prolonged or complicated by other factors. Anticipatory guidance can be provided to families by nurses and HCPs in a variety of practice settings on how to identify and address the most common adjustment and grief reactions that can be anticipated among children after a disaster. Sites that provide medical care to children should be designed to minimize the likelihood of contributing to the additional stress of children. Psychological distress may present as symptoms that mimic serious physical conditions. Time spent on understanding the patient’s psychological distress and implementing effective brief interventions may expedite the delivery of appropriate medical care and promote resiliency.
The authors define disasters, provide statistics about their scope and magnitude, and describe children's and adolescents' typical reactions. In addition, the authors present a conceptual framework for organizing and understanding factors that influence the development and maintenance of disaster-related reactions. This chapter provides an overview of the types of disasters, the primary reactions children display as a consequence of their exposure to disasters, and a general framework for considering the factors that influence the development and maintenance of children's postdisaster reactions. The authors also discuss the main reactions that have been documented in children following disasters and present a model that helps organize and understand children's reactions to disasters. The model incorporates characteristics of the disaster, child, and postdisaster recovery environment. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Long-standing theory suggests that quality of the mother's (or primary caregiver's) interaction with a child is a key determinant of the child's subsequent resilience or vulnerability and has implications for health in adulthood. However, there is a dearth of longitudinal data with both objective assessments of nurturing behaviour during infancy and sustained follow-up ascertaining the quality of adult functioning.
We used data from the Providence, Rhode Island birth cohort of the National Collaborative Perinatal Project (mean age 34 at follow-up, final N=482) to conduct a prospective study of the association between objectively measured affective quality of the mother-infant interaction and adult mental health. Infant-mother interaction quality was rated by an observer when infants were 8 months old, and adult emotional functioning was assessed from the Symptom Checklist-90, capturing both specific and general types of distress.
High levels of maternal affection at 8 months were associated with significantly lower levels of distress in adult offspring (1/2 standard deviation; b=-4.76, se=1.7, p<0.01). The strongest association was with the anxiety subscale. Mother's affection did not seem to be on the pathway between lower parental SES and offspring distress.
These findings suggest that early nurturing and warmth have long-lasting positive effects on mental health well into adulthood.
Childhood maltreatment in the United States was recently recognized as a major public health problem by several influential sources including the World Health Organization and the Institute of Medicine (1,2). An extensive survey conducted by the National Incidence of Child Abuse and Neglect (NIS3) revealed that roughly 1.5 million children were abused or neglected in 1993. This number of documented cases most likely underestimates the true prevalence, given that many cases of maltreatment go unrecognized (2). Moreover, according to the three available NIS reports, the incidence of childhood maltreatment has been steadily increasing over the past 3 decades (see also NIS4 for a good summary of this issue). Although increased reporting might explain some of the data, it is unlikely to explain this alarming trend fully (3). In the absence of effective interventions, maltreated children go on to develop a host of behavioral, emotional, cognitive, and medical sequelae that are chronic and in many cases refractory to treatment (2,4–6). The relationship between early life adversity (ELA) and mental illness has now been documented with both retrospective and prospective studies (reviewed in [2]), and several reports have consistently documented that more than one-half (!) of the individuals with chronic mental illness have been physically, verbally, or sexually abused early in life (7,8). Although most clinicians and researchers will endorse the notion that ELA is associated with increased risk for chronic mental illness, few appreciate the true magnitude of this problem. Better awareness of the burden that exposure to ELA places on adult psychiatric services represents the first step necessary towards transforming current psychiatric interventions. This paradigm shift should substitute the current focus on symptom-reduction with one that focuses on prevention and incorporates a neurodevelopmental framework to diagnose and treat ELA-associated psychopathology. These interventions will require a sound biological understanding of normal neurodevelopment and how ELA interferes with this process.
Child abuse is associated with markedly elevated rates of major depression (MDD) in child, adolescentt, and adult cohorts. This article reviews preclinical (e.g., animal) studies of the effects of early stress and studies of the neurobiological correlates of MDD in adults and children, and it highlights differences in the neurobiological correlates of MDD and stress at various developmental stages. The preclinical studies demonstrate that stress early in life can alter the development multiple neurotransmitter systems and promote structural and functional alterations in brain regions similar to those seen in adults with depression. Preclinical and clinical studies suggest, however, that long-term neurobiological changes associated with early stress can be modified by familial/genetic factors, the quality of the subsequent caregiving environment, and pharmacological interventions. Little is known about how developmental factors interact with experiences of early stress and these other modifying factors. Moreover, in cases of child maltreatment, the effects of early abuse are often exacerbated by failures in the child protection system and repeat out-of-home placements. Given the number of factors that impact on the long-term outcome of maltreated children, multidisciplinary research efforts are recommended to address this problem-with foci that span from neurobiology to social policy.
When a disaster strikes, parents are quick to seek out the medical advice and reassurance of their primary care physician, pediatrician, or in the case of an emergency, an emergency department physician. As physicians often are the first line of responders following a disaster, it is important that they have a thorough understanding of children's responses to trauma and disaster and of recommended practices for screening and intervention. In collaboration with mental health professionals, the needs of children and families can be addressed. Policy-makers and systems of care hold great responsibility for resource allocation, and also are well-placed to understand the impact of trauma and disaster on children and children's unique needs in such situations.
Children exposed to a traumatic event may be at higher risk for developing mental disorders. The prevalence of child psychopathology, however, has not been assessed in a population-based sample exposed to different levels of mass trauma or across a range of disorders.
To determine prevalence and correlates of probable mental disorders among New York City, NY, public school students 6 months following the September 11, 2001, World Trade Center attack.
Survey.
New York City public schools.
A citywide, random, representative sample of 8236 students in grades 4 through 12, including oversampling in closest proximity to the World Trade Center site (ground zero) and other high-risk areas.
Children were screened for probable mental disorders with the Diagnostic Interview Schedule for Children Predictive Scales.
One or more of 6 probable anxiety/depressive disorders were identified in 28.6% of all children. The most prevalent were probable agoraphobia (14.8%), probable separation anxiety (12.3%), and probable posttraumatic stress disorder (10.6%). Higher levels of exposure correspond to higher prevalence for all probable anxiety/depressive disorders. Girls and children in grades 4 and 5 were the most affected. In logistic regression analyses, child's exposure (adjusted odds ratio, 1.62), exposure of a child's family member (adjusted odds ratio, 1.80), and the child's prior trauma (adjusted odds ratio, 2.01) were related to increased likelihood of probable anxiety/depressive disorders. Results were adjusted for different types of exposure, sociodemographic characteristics, and child mental health service use.
A high proportion of New York City public school children had a probable mental disorder 6 months after September 11, 2001. The data suggest that there is a relationship between level of exposure to trauma and likelihood of child anxiety/depressive disorders in the community. The results support the need to apply wide-area epidemiological approaches to mental health assessment after any large-scale disaster.
Does stress damage the brain? Studies of adults with posttraumatic stress disorder have demonstrated smaller hippocampal volumes when compared with the volumes of adults with no posttraumatic stress disorder. Studies of children with posttraumatic stress disorder have not replicated the smaller hippocampal findings in adults, which suggests that smaller hippocampal volume may be caused by neurodevelopmental experiences with stress. Animal research has demonstrated that the glucocorticoids secreted during stress can be neurotoxic to the hippocampus, but this has not been empirically demonstrated in human samples. We hypothesized that cortisol volumes would predict hippocampal volume reduction in patients with posttraumatic symptoms.
We report data from a pilot longitudinal study of children (n = 15) with history of maltreatment who underwent clinical evaluation for posttraumatic stress disorder, cortisol, and neuroimaging.
Posttraumatic stress disorder symptoms and cortisol at baseline predicted hippocampal reduction over an ensuing 12- to 18-month interval.
Results from this pilot study suggest that stress is associated with hippocampal reduction in children with posttraumatic stress disorder symptoms and provide preliminary human evidence that stress may indeed damage the hippocampus. Additional studies seem to be warranted.
Pediatricians must address the psychological component - the terror in terrorism - to help children better understand and recover from traumatic events.
Emergency health care providers are often the first to respond to the needs of children after a disaster. Although there has been an increase in research related to the impact of disasters, including terrorist events, on children's mental health, physicians continue to cite a need for additional information and training on the topic. This article provides an overview of recent literature on disasters and mental health, covering children's stress reactions, mental health problems that may arise, and risk factors that affect these reactions. Practical guidance for pediatric emergency health care providers is emphasized, including psychological first aid, recommendations for screening questions to facilitate mental health triage, and an overview of effective mental health interventions. It concludes with a discussion of the impact of providing care in the aftermath of a disaster on the health care professional.
Guidelines for helping children following a trauma or disaster address possible reactions in elementary, middle school, and high school students; possible reactions in teachers; guidelines for teachers of either high school, middle school, or elementary school students; and guidelines for parents of elementary, middle, or high school students. (DB)
ABSTRACTA growing body of research links childhood experiences of abuse and neglect with serious life-long problems including depression, suicide, alcoholism and drug abuse, and major medical problems such as heart disease, cancer, and diabetes. Two basic processes, neurodevelopment and psychosocial development, are affected by early abuse and neglect. Scientists have begun to understand the mechanisms through which these adverse experiences alter child development and produce pernicious mental, medical, and social outcomes. These insights have opened opportunities to intervene to prevent maltreatment and to mitigate its effects. Future success depends on the greater dissemination and refinement of these interventions.
Nurses are often asked to respond to children's questions about death and to advise parents and teachers on how to discuss this topic with children. This article reviews the concepts that children must learn to understand and cope with a death. Cognitive limitations of young children that may result in guilt and misinterpretations are reviewed. Advice is provided on how nurses can assist infants, young children, and adolescents in dealing with deaths of significant others or their own impending death. The importance of identifying and addressing the personal needs of the helper are underscored.
The relationship of health risk behavior and disease in adulthood to the breadth of exposure to childhood emotional, physical, or sexual abuse, and household dysfunction during childhood has not previously been described.
A questionnaire about adverse childhood experiences was mailed to 13,494 adults who had completed a standardized medical evaluation at a large HMO; 9,508 (70.5%) responded. Seven categories of adverse childhood experiences were studied: psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned. The number of categories of these adverse childhood experiences was then compared to measures of adult risk behavior, health status, and disease. Logistic regression was used to adjust for effects of demographic factors on the association between the cumulative number of categories of childhood exposures (range: 0-7) and risk factors for the leading causes of death in adult life.
More than half of respondents reported at least one, and one-fourth reported > or = 2 categories of childhood exposures. We found a graded relationship between the number of categories of childhood exposure and each of the adult health risk behaviors and diseases that were studied (P < .001). Persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4- to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking, poor self-rated health, > or = 50 sexual intercourse partners, and sexually transmitted disease; and 1.4- to 1.6-fold increase in physical inactivity and severe obesity. The number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life.
We found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.
During and after disasters, pediatricians can assist parents and community leaders not only by accommodating the unique needs of children but also by being cognizant of the psychological responses of children to reduce the possibility of long-term psychological morbidity. The effects of disaster on children are mediated by many factors including personal experience, parental reaction, developmental competency, gender, and the stage of disaster response. Pediatricians can be effective advocates for the child and family and at the community level and can affect national policy in support of families. In this report, specific children's responses are delineated, risk factors for adverse reactions are discussed, and advice is given for pediatricians to ameliorate the effects of disaster on children.
Coping with disaster, terrorism, and other trauma The parents’ guide to psychological first aid: helping children and adolescents cope with predictable life crises
- Rh Gurwitch
- M Schreiber
Stress and early brain development (eds) Encyclopedia on early childhood development
- Mr Gunnar
- A Herrera
- Ce Hostinar
- Re Tremblay
- Rg Barr
- Peters Rdev
The grieving student: a teacher’s guide
- D Schonfeld
- M Quackenbush
How to prepare for and respond to a crisis
- D Schonfeld
- R Lichtenstein
- Mk Pruett
- D Speese-Linehan
Pediatric terrorism and disaster preparedness: a resource for pediatricians
- Gl Foltin
- Dj Schonfeld
- Mw Shannon
org/ school-crisis Website maintained by the National Center for School Crisis and Bereavement that includes a range of resources for school personnel and parents of how to support children dealing with loss and crisis that can be freely downloaded by school personnel, families, and others
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The relationship of adult health status to childhood abuse and household dysfunction
- V Felitti
- R Anda
- D Nordenberg
- D Williamson
- A Spitz
- V Edwards
- M Koss