A catastrophe such as an earthquake, hurricane, tornado, fire, flood, or violent acts is frightening to children and adults alike. It is important to explain the event in words the child can understand. Parents should also acknowledge the frightening parts of the disaster when talking with a child about it. Falsely minimizing the danger will not end a child's concerns. Several factors affect a child's response to a disaster.
The way children see and understand their parents' responses are very important. Children are aware of their parents' worries most of the time, but they are particularly sensitive during a crisis. Parents should admit their concerns to their children, and also stress their abilities to cope with the disaster.
A child's reaction also depends on how much destruction and/or death he or she sees during and after the disaster. If a friend or family member has been killed or seriously injured, or if the child's school or home has been severely damaged, there is a greater chance that the child will experience difficulties.
A child's age affects how the child will respond to the disaster. For example, six-year-olds may show their worries by refusing to attend school, whereas adolescents may minimize their concerns, but argue more with parents and show a decline in school performance.
Following a disaster, people may develop Posttraumatic Stress Disorder (PTSD), which is psychological damage that can result from experiencing, witnessing, or participating in an overwhelmingly traumatic (frightening) event. Children with this disorder have repeated episodes in which they re-experience the traumatic event. Children often relive the trauma through repetitive play. In young children, upsetting dreams of the traumatic event may change into nightmares of monsters, of rescuing others, or of threats to self or others. PTSD rarely appears during the trauma itself. Though its symptoms can occur soon after the event, the disorder often surfaces several months or even years later.
Parents should be alert to these changes in a child's behavior:
Refusal to return to school and "clinging" behavior, including shadowing the mother or father around the house
Persistent fears related to the catastrophe (such as fears about being permanently separated from parents)
Sleep disturbances such as nightmares, screaming during sleep and bedwetting, persisting more than several days after the event
Loss of concentration and irritability
Startled easily, jumpy
Behavior problems, for example, misbehaving in school or at home in ways that are not typical for the child
Physical complaints (stomachaches, headaches, dizziness) for which a physical cause cannot be found
Withdrawal from family and friends, sadness, listlessness, decreased activity, and preoccupation with the events of the disaster
Professional advice or treatment for children affected by a disaster--especially those who have witnessed destruction, injury or death--can help prevent or minimize PTSD. Parents who are concerned about their children can ask their pediatrician or family doctor to refer them to a child and adolescent psychiatrist for an evaluation.
THE DEPRESSED CHILD
No. 4 (10/92)
(Updated July 2004)
Not only adults become depressed. Children and teenagers also may have depression, which is a treatable illness. Depression is defined as an illness when the feelings of depression persist and interfere with a child or adolescent’s ability to function.
About 5 percent of children and adolescents in the general population suffer from depression at any given point in time. Children under stress, who experience loss, or who have attentional, learning, conduct or anxiety disorders are at a higher risk for depression. Depression also tends to run in families.
The behavior of depressed children and teenagers may differ from the behavior of depressed adults. Child and adolescent psychiatrists advise parents to be aware of signs of depression in their youngsters.
If one or more of these signs of depression persist, parents should seek help:
Frequent sadness, tearfulness, crying
Hopelessness
Decreased interest in activities; or inability to enjoy previously favorite activities
Persistent boredom; low energy
Social isolation, poor communication
Low self esteem and guilt
Extreme sensitivity to rejection or failure
Increased irritability, anger, or hostility
Difficulty with relationships
Frequent complaints of physical illnesses such as headaches and stomachaches
Frequent absences from school or poor performance in school
Poor concentration
A major change in eating and/or sleeping patterns
Talk of or efforts to run away from home
Thoughts or expressions of suicide or self destructive behavior
A child who used to play often with friends may now spend most of the time alone and without interests. Things that were once fun now bring little joy to the depressed child. Children and adolescents who are depressed may say they want to be dead or may talk about suicide. Depressed children and adolescents are at increased risk for committing suicide. Depressed adolescents may abuse alcohol or other drugs as a way to feel better.
Children and adolescents who cause trouble at home or at school may also be suffering from depression. Because the youngster may not always seem sad, parents and teachers may not realize that troublesome behavior is a sign of depression. When asked directly, these children can sometimes state they are unhappy or sad.
Early diagnosis and treatment are essential for depressed children. Depression is a real illness that requires professional help. Comprehensive treatment often includes both individual and family therapy. For example, cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are forms of individual therapy shown to be effective in treating depression. Treatment may also include the use of antidepressant medication. For help, parents should ask their physician to refer them to a qualified mental health professional, who can diagnose and treat depression in children and teenagers.
CHILDREN AND GRIEF
No. 8
(Updated July 2004)
When a family member dies, children react differently from adults. Preschool children usually see death as temporary and reversible, a belief reinforced by cartoon characters who die and come to life again. Children between five and nine begin to think more like adults about death, yet they still believe it will never happen to them or anyone they know.
Adding to a child's shock and confusion at the death of a brother, sister, or parent is the unavailability of other family members, who may be so shaken by grief that they are not able to cope with the normal responsibility of childcare.
Parents should be aware of normal childhood responses to a death in the family, as well as signs when a child is having difficulty coping with grief. It is normal during the weeks following the death for some children to feel immediate grief or persist in the belief that the family member is still alive. However, long-term denial of the death or avoidance of grief can be emotionally unhealthy and can later lead to more severe problems.
A child who is frightened about attending a funeral should not be forced to go; however, honoring or remembering the person in some way, such as lighting a candle, saying a prayer, making a scrapbook, reviewing photographs, or telling a story may be helpful. Children should be allowed to express feelings about their loss and grief in their own way.
Once children accept the death, they are likely to display their feelings of sadness on and off over a long period of time, and often at unexpected moments. The surviving relatives should spend as much time as possible with the child, making it clear that the child has permission to show his or her feelings openly or freely.
The person who has died was essential to the stability of the child's world, and anger is a natural reaction. The anger may be revealed in boisterous play, nightmares, irritability, or a variety of other behaviors. Often the child will show anger towards the surviving family members.
After a parent dies, many children will act younger than they are. The child may temporarily become more infantile; demand food, attention and cuddling; and talk baby talk. Younger children frequently believe they are the cause of what happens around them. A young child may believe a parent, grandparent, brother, or sister died because he or she had once wished the person dead when they were angry. The child feels guilty or blames him or herself because the wish came true.
Children who are having serious problems with grief and loss may show one or more of these signs:
an extended period of depression in which the child loses interest in daily activities and events
inability to sleep, loss of appetite, prolonged fear of being alone
acting much younger for an extended period
excessively imitating the dead person
repeated statements of wanting to join the dead person
withdrawal from friends, or
sharp drop in school performance or refusal to attend school
If these signs persist, professional help may be needed. A child and adolescent psychiatrist or other qualified mental health professional can help the child accept the death and assist the others in helping the child through the mourning process.
CHILDREN WHO WON'T GO TO SCHOOL (Separation Anxiety)
No. 7
(Updated July 2004)
Going to school usually is an exciting, enjoyable event for young children. For some it brings intense fear or panic. Parents should be concerned if their child regularly complains about feeling sick or asks to stay home from school with minor physical complaints. Not wanting to go to school may occur at anytime, but is most common in children 5-7 and 11-14, times when children are dealing with the new challenges of elementary and middle school. These children may suffer from a paralyzing fear of leaving the safety of their parents and home. The child's panic and refusal to go to school is very difficult for parents to cope with, but these fears and behavior can be treated successfully, with professional help.
Refusal to go to school often begins following a period at home in which the child has become closer to the parent, such as a summer vacation, a holiday break, or a brief illness. It also may follow a stressful occurrence, such as the death of a pet or relative, a change in schools, or a move to a new neighborhood.
The child may complain of a headache, sore throat, or stomachache shortly before it is time to leave for school. The illness subsides after the child is allowed to stay home, only to reappear the next morning before school. In some cases the child may simply refuse to leave the house. Since the panic comes from leaving home rather than being in school, frequently the child is calm once in school.
Children with an unreasonable fear of school may:
feel unsafe staying in a room by themselves
display clinging behavior
display excessive worry and fear about parents or about harm to themselves
shadow the mother or father around the house
have difficulty going to sleep
have nightmares
have exaggerated, unrealistic fears of animals, monster, burglars
fear being alone in the dark, or
have severe tantrums when forced to go to school
Such symptoms and behaviors are common among children with separation anxiety disorder. The potential long-term effects (anxiety and panic disorder as an adult) are serious for a child who has persistent separation anxiety and does not receive professional assistance. The child may also develop serious educational or social problems if their fears and anxiety keep them away from school and friends for an extended period of time.
When fears persist the parents and child should consult with a qualified mental health professional, who will work with them to develop a plan to immediately return the child to school and other activities. Refusal to go to school in the older child or adolescent is generally a more serious illness, and often requires more intensive treatment.
Excessive fears and panic about leaving home/parents and going to school can be successfully treated.
