Coping With Disaster: Suggestions for Helping Children With Cognitive Disabilities

The September 11^th attacks

Most of this country witnessed the September 11^th attacks and subsequent devastation on television. Each of us will live with the memory of the violence and horror of the attack. We are all struggling to understand the scope of this tragedy. Even those of us who watched from a safe physical distance might be vulnerable to traumatic stress reactions.

Direct and indirect trauma

You don't have to be a victim of an attack to be traumatized. Trauma can also be experienced indirectly by watching the disaster on television, or imagining a horrible accident that befell a loved one. The long-term effects of trauma depend on many things, including how direct the trauma was, whether the person suffered injury or loss, the person's coping style, and the support received after the event.

Parents and educators look for ways to help children cope

Parents and educators find themselves wondering how much information to share with children. They are struggling to answer the children's questions, and are unsure what reactions are typical. Fortunately, most children will learn to cope with this trauma over time. There will be many children, however, for whom adapting will take months or years, with stress reactions waxing and waning over time.

This coping guide illustrates ways to help children with cognitive disabilities

This guide provides suggestions for helping children with cognitive impairments or delays to cope with this disaster. Like everyone, children with disabilities have fears and concerns unique to their experiences and skills. This guide includes general information about what to expect. It provides strategies for caregivers and teachers to use with children with mental retardation, autism, or other disabilities affecting learning, communication, and understanding.

Reactions to disaster and loss: What to expect in children:

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. Children with prolonged indirect exposure (including television) may also have trouble coping. Understand that some children may appear relatively unaffected, and this may be okay, especially if their exposure to the disaster was limited. Children exposed to trauma may respond in some predictable ways that are listed below. For most, these responses will diminish over the next few months, especially if the child did not experience injury, loss of a family member, or further trauma.

• Very young children, about ages two to five: 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. Children with cognitive disabilities may experience any of these reactions.
• School-age children, ages five to 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 how someone can come to engage in terrorist acts. Children with cognitive disabilities may experience any of these reactions.
• Adolescents, ages 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. 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. Children with cognitive disabilities may experience any of these reactions.

General strategies to promote coping: What parents and educators can do:

 

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:

• 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 after you turn it off.

• 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 and increase security. 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.

Some specific strategies:

Children with disabilities will benefit from all of the strategies listed above. Maintaining regular schedules may be particularly important for children who rely on routine as a coping method. Because of their information-processing differences, however, children with cognitive disabilities may also require strategies that address their unique needs.

• 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" and "Will we have a war?" The response to "Will there be war?" might be "Our president and other leaders are thinking and planning, and we might have to go to war." Give the child a chance to respond. 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 aircraft involved or 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 11^th occurred, he felt that his being "bad" had caused it. Guilt can be inappropriately attached to an unrelated event.

Therapeutic approaches to traumatic stress in children with cognitive disabilities:

Despite all of the above, some children with cognitive disabilities may develop stress disorders related to their exposure to this traumatic event. These children should be referred to a mental health professional with appropriate training in both stress disorders and cognitive disability. These professionals might use one of the following approaches.

• Relaxation training. Several relaxation techniques can be used to reduce anxiety and fears in children. A child might be taught, for example, to count slowly from one to five, while picturing himself in a pleasant place. Another child might be taught to imagine a scene in which she is slowly backing away from a troubling situation, counting each step as it is taken, and being "free" when she reaches ten steps. A child may learn to breathe slowly and deeply when confronted with a stressful situation. With each of these examples, the child would require a period of instruction in a highly supportive setting and then extensive practice before being expected to use the skill in "real life."

• Social Stories. Social stories are a way to teach social knowledge and skills to students with autism-spectrum disorders. A story is written and illustrated with pictures or photographs from a child's perspective. The story describes a social situation in which a child is having trouble and provides step-by-step guidelines on how to respond. Read these stories together. They provide students with information about other people and their feelings, settings, social cues, and coping. For example, a social story could describe a child entering the playground, feeling anxious, and then telling himself "It's okay, I can do this." The story then would go on to describe how he approaches a friend. He asks to join in play and his friend responds with an enthusiastic "Yes!"

Some other resources on coping with disaster:

Web Resources

Here are a few helpful Internet sites that provide information on coping with disaster and provide specific information about post-traumatic stress in childhood. Many of these include information in multiple languages. This is not an exhaustive list and there are many other helpful resources available.

• National Association of School Psychologists at www.nasponline.org
• American Academy of Child and Adolescent Psychiatry at www.aacap.org
• National Association for the Education of Young Children at www.naeyc.org
• National Center for Post-Traumatic Stress at www.ncptsd.org

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This guide was developed by Anne Farrell, Ph.D., and Daniel Crimmins, Ph.D., of the Westchester Institute for Human Development (WIHD), a University Center for Excellence in Developmental Disabilities Education, Research, and Service at the Westchester Medical Center in Valhalla, NY. We wish to thank the parents, teachers, and colleagues who contributed to the guide and provided examples of problems and their solutions.