Guidelines for Families

Tips for parents to help themselves

When a disaster or other type of tragedy occurs, parents are often concerned with how to best help their children while they are simultaneously trying to deal with their own shock regarding what happened. Children and adults alike often become scared and confused. Like adults, children are most likely to be worried about their family and significant people in their lives.The following tips may guide parents to help themselves and their children cope after a traumatic event:

Allow yourself time to heal. Parents are often so focused on taking care of their families, that they do not take the time to take care of themselves.

Allow yourself time and space to express your feelings about what happened. Be patient with your emotional state, as it is normal after a trauma to experience mood fluctuations.

Ask for and provide support. Spend time talking with other adults who will understand what you are going through.While it is always a good idea to seek support from loved ones, remember that those in your typical support system may be compromised if they experienced the same event. If this is the case, you may want to find out about local support groups.

To the extent possible, engage in healthy behaviors such as eating nutritious meals and getting sufficient amounts of rest. Those who are able to maintain healthy behaviors tend to feel more in control of their lives and are more able to cope effectively. Avoid the use of drugs and alcohol.

Maintain regular routines regarding eating, sleeping and exercising. Keeping to routines is helpful for both parents and children in getting the family back to normal life after a traumatic event.

Avoid making major life decisions. While it may be tempting to move or change jobs after a traumatic event, it is usually best to avoid making major life decisions during times of stress and turmoil.

If you are having difficulty functioning or are unable to perform daily tasks, consult with your physician or mental health professional. Remember that you will be of no help to your family if you are having difficulty helping yourself.

Guidelines for Friends and Family

Family and friends may provide a wonderful source of support for children and families who have been impacted by a disaster or other type of traumatic event. The following tips may be helpful for those who would like to comfort their loved ones during difficult times:

Give practical help. Ask what needs to be done or listen attentively for what might be needed. If you have a particular expertise, offer to share it. For example, someone with a financial background can offer help going through business papers while the parent of a child’s playmate can offer to babysit or carpool.

Avoid stock statements and provide genuine responses. Although they are well meaning, many people recite phrases that may sound empty or untrue, such as “you’ll be fine,”“time heals all wounds,” or “I know how you feel.” People in distress often appreciate just being heard. It is also okay to say, “I wish I knew what to say,” which indicates an open willingness to be there for the person in need.

Avoid judgments and comparisons. People are different, and may have varying reactions to stressful experiences. It is often more helpful to ask someone how they are doing than to tell a story about how someone else handled a similar situation.

Remember that the needs of traumatized people change over time. Usually there is a great deal of activity in the first weeks after a disaster or trauma. Once this subsides, there can be a tremendous void for the person and family. Friends are sometimes most helpful at this time, when others are likely to have moved on.

Helping children with special needs

Children with special needs, such as developmental delays or disabilities, generally have difficulties in the development of sufficient physical, emotional or intellectual capacities to cope with the demands of their environment. Developmental disabilities may include physical disorders such as cerebral palsy and limited vision, language and speech disorders, mental retardation and pervasive developmental disabilities such as autism.

Children with developmental disabilities exhibit different levels of understanding and emotional reactions to events in their environments.They also have different learning styles and patterns when dealing with normal events. Being aware of the impact that a disaster can have on developmentally disabled children is critical for both caregivers and professionals.

The basic principles and tips provided above and in Chapter 11 also apply to helping and supporting children with special needs and developmental disabilities. Yet, the everyday factors that are involved in working with disabled children assume even greater significance in times of crisis. Children with special needs require more time, support, guidance and nurturance to understand and internalize traumatic events than other children. Disabled children’s areas of weakness become more vulnerable when the content of the material is threatening. Following are some considerations to keep in mind when helping disabled children through the immediate crisis and future months.

Understand children's cognitive and emotionla functioning. It is important to understand how a child with special needs processes information on both a cognitive and emotional level. Children’s reactions are influenced by their disability.Take into account the child’s ability and capacity for understanding information, communicating what is heard and expressing feelings. For example, a child with a hearing impairment may not pick up cues and information from an event that involves sounds or language. A visually-impaired child may have difficulty interpreting facial expressions or may be confused by discussion of visual images. A child with mental retardation may not be able to fully understand the significance of an event, but will be impacted by others’ reactions.

Alter language to help children understand. When providing information to children with special needs, it may be necessary to alter language. Children may not be able to understand abstract or complex concepts, such as “being on alert,”“state of emergency” and “rescue efforts.” Rather, when speaking to children with special needs, adults can focus on explaining the situation in simple, concrete terms. It is also important to provide children with enough facts to help them understand a situation without burdening them with all the details of the traumatic or frightening event. Repeating facts to children with cognitive limitations or language comprehension problems is also essential.

Tailor the information to the child’s strengths. It is critical to share information with children while utilizing their strengths. For instance, a child with a language disability may better understand information through the use of visual materials and pictures. Children with limited cognitive abilities may better process information with concrete examples and simple factual statements.

Make sure children understand the facts correctly. When sharing information about a potentially frightening or traumatic event, children may have difficulty grasping all the details or trying to understand the impact of the event on their life.This is especially true for children with special needs. Some children may put information together inaccurately, neglect to consider vital aspects of information shared and come up with fanciful explanations. Children may also misattribute the reasons behind an event and may consider the event a larger threat to themselves and their family than may actually be the case.When providing children with facts about an event, it is important to check and assess whether they fully grasp the information provided. When possible, ask children to write, tell or draw what they know about the event, and correct any misconceptions and misattributions through discussion.

Correct inaccuracies. Children with cognitive or emotional difficulties may be more susceptible to believing false information and rumors.This is especially pertinent for school-aged children, who rely on their peer group for information and socialization. It is important that children are correctly informed and do not share, or are not swayed by, inaccurate information.

Be attuned to changes in symptoms. Many children with disabilities provide specific signs that signal their concern about their own and their family’s safety.  Children with special needs may have more difficulty than their peers in expressing their fears, anger and concerns.Warning signs of distress may be facial expressions, nervous tics, changes in speech patterns, sweating, feeling sick or increased irritability and angry outbursts. Problems may also be reflected in behavior, such as withdrawal, refusal to participate in activities, separation problems or acting out.

Maintain regular routines and schedules. Children with special needs are faced with daily challenges, such as maneuvering a wheelchair and taking medications regularly. At times of crisis, routines will help reduce anxiety and provide children with a sense that things are gradually returning to normal.

Prepare children for emergencies. Be sure that children with special needs are aware of procedures to be followed in an emergency. Children should know the specific people responsible for them and who to contact in the case of an emergency. Make certain that you are familiar with the school’s emergency procedures, and plan for special accommodations, such as assistance with a wheelchair or a guide for a visually impaired child. Practicing safety plans can reassure children that things will go smoothly and highlight any unforeseen difficulties with organization and management, such as maneuvering a wheelchair.

Engage in open discussion. When children ask questions or are ready to talk about events, do not avoid discussions – as hard as they may be.Avoidance of difficult subjects, particularly about death, transmits the message that a topic is taboo. Silence or avoidance can eventually create more anxiety and confusion.

Validate children’s feelings. Assure children that their perceptions that events are scary are valid and that even adults can be frightened or worried. This is especially important for children with emotional difficulties or children who have difficulty interpreting others’ feelings. In addition to validating children’s concerns and feelings, reassure them that adults are in control and that they can make decisions to take care of the children.

Limit exposure to the media. Limiting media exposure and replays of images that can be overwhelming are important for all children.Younger children and those with special needs may believe that each replayed incident on television is a new, additional event. Children may also misunderstand information presented in the media, and believe that they are at greater risk than they actually are.Watch news reports with children and make sure that they correctly process the information. Children with disabilities may have experienced trauma previously in their lives, which puts them at risk for recurrence of previous reactions to stress.

Monitor your responses. Many developmentally disabled children are unusually adept at reading their caregivers’ or teachers’ non-verbal messages, especially facial cues. Caregivers need to monitor their responses in order to be as effective as possible.

Seek referrals. Children with emotional or behavioral problems may require additional short- or long-term assistance in managing their reactions. It is important to be prepared for increased reactions, such as anger, withdrawal and aggression. Children with cognitive difficulties or language disorders may be more likely to express their fears, concerns and anger through emotional outbursts or acting out behaviors. Caregivers and teachers should be prepared to help children understand the events, provide a safe and predictable environment and seek additional professional help to enhance children’s coping strategies.

Stress reduction techniques for adults and children

Coping with difficult life events requires understanding and patience.There are many practical techniques that individuals can do to help themselves when they feel stressed, overwhelmed, sad, angry and scared. Individuals should choose what is right for them and be careful not to judge others or force them to be a certain way or to use a specific technique.The following techniques may be helpful to use on one’s own or when seeking additional help from a mental health professional:

• Write down specific worries and an antidote for preventing or fixing the situation
• Develop a personal safety plan with up-to-date names and phone numbers of important support people
• Keep a journal of thoughts and feelings including what happened right before they occurred
• Make a list of things you did to get through other tough situations and use them again
• Practice what to say and do in a difficult or stressful situation
• Use relaxation techniques
• Take slow deep breaths from the belly
• Tense and relax different muscle groups; for children, pretend you are a toy soldier standing very stiff then
  change to a melting ice cream cone to relax
• Imagine a safe and calm place—a cozy reading corner, a sandy beach on a breezy afternoon
• Give yourself a treat—a warm bath, a massage, a candy bar—when you feel sad or upset or after handling a
  tough situation
• Spend time with a family member or special friend, or play with a pet
• Watch a funny movie or play a favorite game
• Help plan a memorial activity or event
• Get involved: organize a fund raiser or volunteer
• Give yourself or child permission to take a break from regular activities
• Get enough rest and food to stay healthy and strong

A note on trauma and bereavement

Chidren’s reactions will be more complicated when they have lost someone as a consequence of the disaster or trauma. For specific information on helping children cope related to bereavement, see Chapter 11.

A note on natural disasters

This section provides information on helping children cope following traumatic events, including terrorism, natural disasters and war. For additional information on guidelines to help children prepare for and cope following a natural disaster, such as a hurricane, see Chapter 5.

About the NYU Child Study Center

The New York University Child Study Center is dedicated to increasing the awareness of child and adolescent psychiatric disorders and improving the research necessary to advance the prevention, identification, and treatment of these disorders on a national scale. The Center offers expert psychiatric services for children, adolescents, young adults, and families with emphasis on early diagnosis and intervention. The Center's mission is to bridge the gap between science and practice, integrating the finest research with patient care and state-of-the-art training utilizing the resources of the New York University School of Medicine. The Child Study Center was founded in 1997 and established as the Department of Child and Adolescent Psychiatry within the NYU School of Medicine in 2006. For more information, please call us at (212) 263-6622 or visit us at http://www.aboutourkids.org/.