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Assessing Traumatized Children
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In the last section, we discussed three contributing factors in children's reactions to disaster and terrorism. These three contributing factors were aspects of traumatic exposure, preexisting characteristics of the child, and aspects of the recovery environment.
In this section, we will discuss three focus areas for assessing children exposed to disaster or terrorism. These four focus areas are, the child's behavior and emotion, the severity of the stressors, and coping.
Becky, age 6, had been staying overnight at her grandmother Irene's house when a tornado touched down in Irene's neighborhood. Fortunately, Irene had been aware of the tornado warning, and had time to awaken Becky and take her down to the basement. Although neither Becky nor Irene was seriously hurt, Irene's home had been destroyed, and it took several hours for rescue workers to clear away enough rubble to let Becky and Irene out.
A week later, Irene and Becky's father Max brought Becky in to therapy. Irene stated, "I know the tornado has affected Becky, but I can't tell how badly. I want to know what to look for that might indicate she's not doing well."
3 Focus Area For Assessing Children Exposed to Disaster or Terrorism
♦ Focus Area # 1 - The Child's Behavior and Emotion
I explained to Irene that the first focus area for assessing children exposed to disaster or terrorism is the child's behavior and emotion. As you know, the assessment of a child's emotional response is usually indicated by self-report and by play. Assessments of a child's behavior usually involve reports from adult caregivers, teachers, and sometimes the children themselves.
I stated to Irene, "Some behaviors you may want to watch for with Becky are sleep difficulties, a change in personality, continual telling or playing out of the tornado, or Becky losing interest in activities she normally enjoys. Some children may also exhibit behavioral regression. For example, an older child might suddenly begin thumb-sucking or bed-wetting again for the first time in years. In addition, you might watch for fear and anxiety responses in Becky. Some children might display sudden panic or distress, especially in response to loud noises, or experience extreme separation anxiety."
In our next session, Irene stated, "Well, I haven't seen any of the behavior you told me to look out for, really. She's certainly not acting younger or fearful in the daytime. She's actually become a bit of a daredevil! She used to be real careful about her bike, but the other day I caught her trying to jump the creek behind our house on it! I asked her if she was scared, and she said she wasn’t afraid of anything! When she plays with her friends, she’s always been the villain or the monster. But at night, she has terrible nightmares, and insists on having a bright nightlight."
I stated to Irene, "It sounds like Becky is experiencing something called fear denial. Children who experience fear denial go to great lengths to convince themselves and others of their power and immunity. These children are so desperate for a sense of power and control that they devote themselves to convincing others of their invulnerability."
♦ Technique: Find a Physical Outlet
I suggested to Irene that one way she might address Becky’s fear denial at home is the Find a Physical Outlet technique. I stated to Irene, "Participating in sports or other structured physical activities can help children who have been traumatized regain a sense of control. By helping Becky find a sport that she is very good at, or has a lot of fun doing, you can put her in a position to have positive experiences that are incompatible with her sense of powerlessness and fear. It’s hard for a child who is doing something active and fun to feel powerless or victimized."
After discussing Becky’s interest, Irene tried enrolling Becky in an Aikido class. Aikido is a form of martial art that specializes in redirecting physical attacks, to stay safe while not hurting the attacker. Irene later reported, "Becky has been having a lot of fun at Aikido! She’s able to sleep a lot better, and she wants to play the monster a lot less. She’s even been mentioning that her instructor says it’s ok to be afraid, even if she’s not coming right out and telling me about her fears."
♦ Focus Area # 2 - The Severity of the Stressors
A second focus area for assessing children exposed to disaster or terrorism is the severity of the stressors. Clearly, one aspect of this is assessing what degree of threat or loss resulted from the event. As mentioned in Section 8, other areas important in assessing the severity of the stressors involved in a child’s experience can be disruption of everyday life, duration and intensity of life-threatening events, and proximity to the event.
♦ Focus Area # 3 - Coping
In addition to the child’s behavior and emotion, and the severity of the stressors, a third focus area for assessing children exposed to disaster or terrorism is coping. I have found that through assessing a child’s coping style, I have an opportunity to involve the child in determining how coping behavior functions, and to invite the child to modify coping behaviors, or develop a wider range of coping responses.
Would you agree?
As you know, measures of appraisal related to thoughts, beliefs and worries about future disasters, such as in Rustemli and Karanci’s Earthquake-Related Cognitions Questionnaire, optimism, and future orientation, can also be extremely valuable. Data from these measures can help therapists identify covert verbalizations that precipitate arousal, distress, or negative affect. This in turn can lead to emotion-focused coping efforts. I have also found it valuable to assess children’s social support networks.
As you have experienced in your practice, children who witness and survive disasters need to talk about their experience and have access to others who are emotionally and behaviorally supportive in order to develop coping skills.
Think of a child you are currently treating for exposure to disaster or terrorism. Does he or she have an adequate support network?
In this section, we have discussed three focus areas for assessing children exposed to disaster or terrorism. These four focus areas are, the child's behavior and emotion, the severity of the stressors, and coping.
In the next section, we will discuss helping parents handle two kinds of questions children may ask about emergency preparedness in an age appropriate manner. These two kinds of questions are, questions about safe rooms, and questions about armed police and military personnel.
Peer-Reviewed Journal Article References:
Barnett, E. R., Jankowski, M. K., & Trepman, A. Z. (2019). State-wide implementation and clinical outcomes associated with evidence-based psychotherapies for traumatized youth. Psychological Trauma: Theory, Research, Practice, and Policy, 11(7), 775–783.
Fitzgerald, K., Henriksen, R. C., Jr., & Garza, Y. (2012). Perceptions of counselors regarding the effectiveness of interventions for traumatized children. International Journal of Play Therapy, 21(1), 45–56.
Gilkey, S. (2010). Review of Treating traumatized children: Risk, resilience and recovery [Review of the book Treating traumatized children: Risk, resilience and recovery, by D. Brom, R. Pat-Horenczyk & J. D. Ford, Eds.]. Traumatology, 16(1), 66–67.
Grolnick, W. S., Schonfeld, D. J., Schreiber, M., Cohen, J., Cole, V., Jaycox, L., Lochman, J., Pfefferbaum, B., Ruggiero, K., Wells, K., Wong, M., & Zatzick, D. (2018). Improving adjustment and resilience in children following a disaster: Addressing research challenges. American Psychologist, 73(3), 215–229.
Hansel, T., Osofsky, H., Speier, A., & Osofsky, J. (2019). Postdisaster recovery and resilience: The mediating influences of mental health and environmental quality of life. Traumatology. Advance online publication.
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