Impact Feature Issue on Disaster Preparedness and People with Disabilities

People respond differently to disaster. Some may appear unaffected, and others show distress, rage, and fear. Children’s reactions vary according to many factors, including their ages, abilities, and experiences. The children most directly affected are likely to have the greatest difficulty coping, but children with prolonged indirect exposure (including seeing events on TV) may also have trouble coping.

• Very young children (about 2-5): sleep disturbance, difficulty separating from parents, fussiness, confusion, fears about safety, somatic symptoms (stomachaches), exaggerated startle to loud noise, and re-enactment of the events through play. These reactions will be most evident in children with greatest exposure to the trauma and when parents display a great deal of distress.

• School-age children (ages 5-11): worries about the safety of loved ones, attention to adult reactions, withdrawal or hyperactivity, repetitious play, impaired concentration and academic performance, sleep disturbances and nightmares, magical ideas about how the disaster might have been averted, and questions about why such disasters can happen.

• Adolescents (12 to around 18): sadness, outrage, risk-taking behaviors, substance use or abuse, sleep or eating disturbances, anger or rage, talk of retaliation, increased sense of alienation, shifts in peer groups, and focus on death. The adolescent thinking style tends to be all-or-nothing and teens are especially vulnerable to peer influences and failing to consider the consequences of their actions. As such, teens may be particularly vulnerable to impulsive responses.

General Strategies for All Children

• Natural supports work best. Children with cognitive impairments, like other children, adapt best in their own environments and routines. There is comfort in the familiar, so allow children to go about routines of school, recreation, and play. Consider the community supports you would turn to in any time of need: extended family, religious faith, community organizations, and recreational activities that provide outlets for tension and opportunities to spend time together. Use your support network. Take care of yourself so that you can be available when children need guidance.

• Education helps. Educate yourself about the impact of trauma and how it changes over time. Knowing what to expect helps you be prepared to provide support. For example, expect children to misunderstand some of the things they hear and see. Be prepared to learn what they know and supply accurate and timely information. Teach older children that recovery is a process: it takes time, everyone responds uniquely, and there is no “right” way to feel. There are right ways to act, however, and children need good role models. Help them learn about federal, state, and community leaders whose responses are constructive and inspire confidence. Use reputable resources to guide your own education efforts.

• Focus on doing. When you demonstrate caring for yourself and others, you are engaged in coping. It is important to express feelings, but coping is also about learning, thinking, and doing. Some specific steps you can take are the following:

  • Limit further exposure to trauma. Given how immersed we are in unfolding events, assume that children know about them. It is important, however, to limit ongoing exposure to the trauma. For younger children, turn off the television during the news. Set aside some time to look at newspaper stories and photographs and answer questions. For older children, watch the news together. Change channels if you feel the media coverage is not constructive. Talk about what you see while you are watching and afterward.

  • Address concerns about safety. Discuss safety with children. Children will be assured by knowing steps authorities are taking to protect the public. Explain in concrete terms how our leaders are working together to restore normalcy. Be honest and calm about risk; don’t promise that nothing like this will happen again. Explain that most of us will live long and grow old. Reassure children that you will do everything in your power to protect them.

Additional Strategies for Children with Disabilities

• Use language the child understands. Speak at the child’s language level, giving short explanations. Children often ask questions that adults don’t have answers to, such as “Why did this happen?” It’s also okay to admit there are things you don’t know. Abstract terms may lead to misconceptions. Avoid statements like “This was tragic and many lost their lives. One of John’s loved ones passed on in the collapse.” Instead, say, “There was a big explosion and many people died. John’s uncle was killed.”

• Check the child’s understanding. Ask often about what children are thinking and feeling. Encourage them to draw pictures if they are able. Draw, paint, or color with them. Provide choices of emotions they may be experiencing. Use pictures that represent “sad” or “upset” if they are not good at expressing themselves with words. Ask open-ended questions like “What have you seen and heard about the World Trade Center?” Prompt them with questions such as “What happened next?” Avoid yes/no questions that do not encourage children to talk more.

• Expect misunderstanding. Children with language and cognitive disabilities may be particularly vulnerable to misconceptions. Multiple television rebroadcasts may be confusing and children may become afraid that the attack continues or has started anew.

• Correct misunderstandings. A news report about requests for blood donations confused one child who could not understand why someone would take people’s blood from them. Ask children about what they hear and tune in closely to their reactions, including facial expressions. In this case, you might show the child a photo of someone donating blood and tell how this helps. If you donate blood, show the child your Band-Aid and explain that no one hurt you.

• Repeat your responses patiently. Children may have questions about these events and ask them repetitively. Use clear examples and repeat yourself as needed. If you are aware of misconceptions a child has, you are in a good position to help. Gently and carefully repeat correct information and be sure the child grasps what you mean. Later, check in again about the same information because misconceptions can be hard to shake. For example, one child came home from school crying. She said the grandparents of three classmates died in the World Trade Center attack. Her mother talked to a neighbor and learned that the child’s teacher talked about the attack. Luckily, no one in the class was directly affected. The teacher asked whether any students remembered someone dying and three children said that their grandfathers had died previously. The child’s mother corrected her misperception. Later when her father came home, the child repeated the story, again stating that the grandfathers had been killed in the attack. Two or three more conversations were necessary before the child grasped the difference. Gentle repetition reduced her distress and made it less likely she would repeat the story incorrectly.

• Use pictures and talk together. Each discussion offers an opportunity to help children understand and cope. Provide information to more than one sense at a time, allowing children to see, hear, touch, talk, and do. For very young and elementary-age children, show photos of recovery operations. Tell them how the firefighter or police officer pictured is helping. This can be done many times over the coming days. For older children and adolescents, talk about television and newspaper coverage every day. Expose them to leaders who appear strong, sympathetic, and reasonable.

• Identify the human element of the tragedy if inappropriate questions are asked. Some children may want to talk about aspects of the tragedy that may seem irrelevant or insensitive. A child with restricted interests might want to review details about the equipment used in the recovery effort. Answer the questions, but remind the child that this is a sad time because so many people have died. If an attempt to redirect the child does not work, try to structure or contain this conversation. Provide times and places for the child to discuss this with you. Give the child guidelines for talking to others in a sensitive way. Offer “okay” topics such as the number of rescue personnel on the scene or which bridges and tunnels have reopened.

• Look at what might be upsetting. One child became upset when she heard a television show with gunshots. She thought that a war had started. If a child has a strong emotional response, look first at the immediate context. Another child had recently done something for which he was scolded. When the disaster of September 11th occurred, he felt that his being “bad” had caused it. Guilt can be inappropriately attached to an unrelated event.

Despite all of the above, some children with cognitive disabilities may develop stress disorders related to their exposure to a traumatic event. They should be referred to a mental health professional with appropriate training in both stress disorders and cognitive disability.