Children need help to cope with disaster

Children who don't talk about high-profile disasters such as the September 11, 2001, terrorist attacks or, before that, the shootings at Columbine High School aren't coping - they're avoiding. Pediatricians can help them come to terms with their fears.

Large-scale disasters often involve trauma-spectrum disorders, explained Lenore Terr, MD, long-time child health advocate and author who has studied the effects of terror on children's psychological health. But instead of reacting to specific threats to self, family, and community, children are trying to deal with distant events and vague threats. Their fears are as vague and as difficult to comprehend as the distant event that triggered them.

"After 9/11, it was clear that children were affected," Dr. Terr told an audience this week at the AAP 2004 National Conference and Exhibition. "But the source of their disturbance was often unclear. Until you understand why and how a child is affected by distant events, it is hard to help them cope with the consequences."

The coping process has three steps, Dr. Terr explained.

The first is abreaction, expressing emotional connection to the event. There are no wrong emotional reactions to disaster, Dr. Terr emphasized - just honest ones. The typical adult reaction, feeling empty or numb, does not count.

"The child needs to say what the emotional reaction is," she said, "and you have to listen. Depending on the age of the child, you may need to help by giving them the vocabulary to emote."

The second step is context - talking through the who, what, why, when, were, and how of the event.

"This is where you can bring your own experience to bear," she said. "For children who are concerned about other children having been hurt in 9/11, you can point out that children didn't work or go to school in the World Trade Center. So unless they happened to be visiting, there would not have been children directly involved."

Putting the disaster into context also means explaining why. 9/11 wasn't a random event, Dr. Terr noted - it was the result of deliberate actions. Being able to assign a cause, such as terrorism, is less frightening than a disaster that happens for no reason at all.

The final step is correction. That doesn't mean that a disaster can be undone, Dr. Terr cautioned, but that the child identifies a behavior or action, internally or in society, that, if changed, might prevent a similar disaster from happening again.

"Children are much more observant and resilient than adults believe," she said. "They are very detail-oriented. You can help the work through the details in ways that ease their concerns."