A Quick Reference Guide for Posttrauma Home and School Care

The following "quick reference guide" is adapted from Cynthia Monahon's (1997) book, Children and Trauma: A Guide for Parents and Professionals. As she pointed out, all trau­mas, whether a car accident or a hurricane, provoke common symptoms, such as fearful­ ness, nightmares, and even personality changes in a child (see chapter 3 for a discussion of the effects of disasters on children), and these changes in the child may be worsened by the parents' anxiety. However, if parents under-stand the effects of trauma and learn ways to respond to their children's symptoms, there is a greater likelihood that the children's sense of safety and balance will be restored.

Changes in behavior that signal the need for professional help. Changes in a child's behav­ior should diminish within a week or so, although some may need a few weeks to "bounce back" A few children, however, do not function well again without some type of therapeutic intervention. When a child's behavioral changes in the weeks or months after a disaster are extreme and remain extreme, professional help is probably neces­sary. Affirmative answers to the following questions (each of which highlights a warn­ing sign to look for) signal that referral to a mental health agency is warranted.

When exposure is the criterion, consider the following questions:

• Did the child lose family members or friends in the event?
• Was the child physically injured in the event?
• Does the child consider herself or himself to have been in extreme danger during the event?
• Was the child present in a previous disaster?
• Is the child involved in another individual or family crisis?

When experience is the criterion, consider the following questions:

• Does the child talk about feeling detached from his or her body?
• Is the child severely depressed and with-drawn?
• Does the child seem excessively agitated and restless?
• Does the child talk a lot about death?
• Does the child complain of significant memory gaps?
• Does the child show uncharacteristic signs of self-neglect?
• Does the child engage in obviously self-destructive behavior, intentionally hurting herself or himself, or having repeated "accidents" that result in injury?
• Does the child demonstrate a drastic change of personality or temperament?
• Does the child hallucinate, appear disori­ented, or otherwise show obvious signs of disturbed mental processes?
• Does the child evidence, for a month or longer, symptoms that are considered nor­mal but that disrupt social, mental, or physical functioning?

Recommended responses to children of differ­ent ages. Children may be grouped into three broad categories based on their age: early child-hood, approximately ages five through 11; preadolescence, approximately 11 through 14; and adolescence, approximately 14 through 18.

For children in early childhood, regressive behavior is the most typical postcrisis response; children in this age group may find it very difficult to deal with the loss of pets or prized objects. Helpers should:

• respond to regressive behaviors with patience and tolerance
• conduct individual or group play sessions
• relax expectations in school and at home (with a clear understanding that this change is temporary and that the normal routine will resume when the children are feeling better)
• provide opportunities for structured, but not demanding, chores and responsibilities at home and at school
• rehearse any safety measures to be taken in the event of a future disaster

For preadolescent children, peer reactions to the crisis are important. Preadolescents want to believe that their crisis reactions are similar to others'. Helpers should

• provide same—age group activities that continue known routines
• work in groups, and rehearse appro­priate behaviors in the event of a future crisis
• allocate appropriate social roles and responsibilities

Because adolescents' activities and interests are focused primarily on their peers, youths between 14 and 18 years old are especially distressed by any disruption of their peer-group activities. Helpers should

• encourage participation in any communi­ty rehabilitation and reclamation work
• encourage the resumption of social activi­ties (such as athletics, clubs, and school groups) when the children are ready
• encourage discussion of the crisis event and reactions with peers, extended family members, and significant others
• reduce expectations temporarily for per­formance both in and out of school.