Expert Commentary

* Family and Child Intervention: Families Impacted by Trauma and Tragedy

Jennifer Newman, PhD

Division of Trauma Psychology
North Shore / Long Island Jewish Health System
New Hyde Park, NY

Children who have experienced trauma and disaster are prey to adverse reactions which can include PTSD, sleep problems, depression, separation anxiety and difficulties with anger and mood control. Younger children will experience irritability, and changes in behavior, eating habits and sleep. Children lodged in evacuation centers and temporary housing will experience stressors in excess of those encountered during the disaster itself. Particularly disruptive for children is the loss of access to toys, favorite foods, familiar routines and creature comforts they are familiar with. Some of the most serious stress manifestations of trauma response in children include somatic complaints (e.g. headaches, “tummy aches”); and cognitive shift, or the loss of a prior ability to focus and process information on a given topic.
Immediately following the initial assessment, psychological first aid, (i.e. making children and families feel safe and secure in a disrupted environment), is the best initial approach. Once baseline has been established, empirically-based interventions targeting children should start with trauma-focused cognitive behavioral therapy (TF-CBT) and expand to include cognitive processing therapy (CPT) and prolonged exposure (PE) techniques with parents. Therapy is best matched to age group. For infants/toddlers, the importance of having an adult caregiver-figure to attach to is paramount. Preschoolers need predictability and structure in unfamiliar situations. They may use techniques like “magical thinking” to explain distressing events and may also try to impose control by creating scenarios which will yield a more comforting outcome. School age children and adolescents have greater understanding, but may still feel powerless. Thus, maintaining routines or structure is important, as is giving kids tasks to encourage responsibility and a sense of control.
Overall, key areas requiring attention are: 1) Persistence of lasting changes in a child’s behavior, 2) “Atunement”. Communications channels open and family members “hearing” each other, 3) How the child is coping, 4) Use of developmentally appropriate language, 5) Awareness and limitation of media and social exposure to disaster-related information, 6) Understanding that children may show ambivalence in their motivation to talk. 7) Even very small children can overhear and understand what is being discussed elsewhere in a living area. On the positive side, exposure to trauma may provide an opportunity for growth. Of particular importance, have a network of providers available who can both train each other and bring new perspectives to bear, particularly when disasters affect rural areas.



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