Mental Health - Helping Children

PHOTO: IMC

After the quake, a little girl plays in the rubble of her own home.

What we already know from previous wars and disasters is firstly that children are resilient and the majority do find ways to cope even with massive losses. Even so around 30- 40% are likely to have upsetting symptoms and disturbed experiences in the short term, and 10% be more seriously affected in the long term in a variety of ways.

Grief and loss are normal non pathological experiences that are part of life and all societies and cultures have evolved methods of mourning and recovery to cope and support each other through the painful feelings evoked. In a disaster of this scale most of these normal processes are unavailable and the key one of social support is wiped out by the destruction of entire communities while individuals are left alone to grieve multiple losses.

Traumatic grief, the feelings evoked by sudden unexpected and horrific loss, is much more difficult to cope with because the response to traumatic experience can interfere with normal mourning. For example the avoidance that may be protective in coping with the trauma, may prevent the acceptance that is necessary for coming to terms with the loss. A child cannot summon up pleasant memories of his past life with his mother because every time he does he thinks of the wave smashing into the kitchen and carrying her off and his feelings of panic and fear reoccur. Better not to think about mother, but then he cannot mourn her. He feels guilty surviving and instead of comforting dreams of happy times with her he has nightmares of the means of death, He fears sleep and there is no satisfactory focus for anger. We need to deal with traumatic symptoms first before grief work can be done.

Children are vulnerable in particular ways:

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1. Understanding of death and catastrophe is age related. For example, under fives in western societies have little understanding of the permanence of death and think in egotistical and magical ways: they can see themselves as being in some way responsible for events. So explanations need to be tailored to culture and cognitive development and to address how it happened and why.

2. Children’s well-being and attitudes will relate closely to those of their surviving caretakers. Children do best with competent caretakers who are coping well, themselves. Unaccompanied and orphan children are particularly vulnerable.

3. Younger children may lack the mobility and resources to seek out valid alternative networks of support or initiate normalizing activities. They may accept whatever is on offer and are thus vulnerable to abuse.

Symptoms to expect in most children include some or all of the following:

Immediately:

Shock and disbelief
Dismay and protest
Apathy and feeling stunned
Continuation of usual activities

Any of the following can occur and should be seen as part of the normal response:

Anxiety
Vivid memories
Sleep problems
Sadness and longing
Anger and acting out behavior
Guilt, self reproach and shame
School problems
Physical complaints
Regressive behavior
Social isolation
Fantasies
Personality changes
Pessimism about the future
Rapid maturing

Research evidence suggests that the loss of parents in childhood can be associated with a greater risk of psychiatric disorder in later life. We also know that massive traumatic events that take place over a short period without preparation, that require a major shift in assumptions about the world, and have lasting implications, have more severe mental effects.

In the longer term you might expect a proportion to develop: Stress disorders, (panic and anxiety), phobias (common after 9/11), anxiety and depression, behaviour problems, school problems. We also know that there are many things we can do in the short medium and long term to protect children from adverse mental effects:

Provide consistent, enduring appropriate care
- Reunite children with their families or extended families as soon as possible
- In the absence of family create enduring family type networks with a low ratio of caretaker to children.
- Consistent care-giving by one or two caretakers, not multiple volunteers is essential to prevent attachment problems particularly in younger children
The more continuity with the child’s previous life the better. Children may wish to avoid traumatic reminders, especially at the outset, but complete removal from a familiar environment will cause more pain and problems in the long run.
Support the carers by attending to basic needs and their own mental states.
Facilitate normal grieving and mourning- with memorials for absent bodies, appropriate religious ceremonies.
Don’t hide the truth.
- Children need clear, honest, consistent explanations appropriate to their level of development.
- They need to accept the reality of the loss, not be protected from it.
- Magical thinking should be explored and corrected. What is imagined may be worse than reality and children may be blaming themselves for events beyond their control.
Do not insist that the child "debriefs" or tells the story of their loss. This may not be therapeutic or appropriate. Not all cultures put a high value on the ventilation of individual feelings, as Western culture does. The therapist's goal should be to encourage a supportive atmosphere for the children, where open communication is possible, difficult questions answered, and distressing feelings tolerated. This means that the child will be free to express their grief in the manner they find appropriate to the person they most trust, and at a time of their own choosing.
Symptomatic relief: Help the family to cope with traumatic symptoms if they exist. Give the parents information as to what to expect and straightforward management advice.
Help the child maintain connection with the lost parents – find mementoes if possible or let the child draw pictures, make objects. Answer the child's questions about the dead relative.
Restart normal educational and play activities as soon as possible.

PHOTO: Annie Turnbull

Dr. Lynne Jones distributes finger puppets to children in Omia Anyima so they can participate in her storytelling.

From "Guidance Note to IMC Staff – Psychological effects of disaster
with particular reference to children by Dr. Lynne Jones, Child Psychiatrist