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Collaboration in Working With Children Affected by Disaster 135

Table 10.2 Risk Factors for Children in Disaster

Circumstances that prevent parents from providing opportunities for secure attachments
to their children, such as parental depression, anxiety, or parents’ own posttraumatic
stress disorder.
A pattern of avoidant attachment rather than secure attachment (such children might
appear indifferent, or inhibited, with only superficial compliance or concern).
Prior trauma (neglect, abuse, violence, or loss).
Preexisting mood disorders or anxiety disorders because such children may be more likely
to appraise disastrous situations pessimistically, seeing adversity as widespread, lasting,
and one’s own fault.
Not having words for feelings (alexithymia), leading to avoidance or hyperarousal.
Lower cognitive ability and consequent trouble coping with trauma.
Intense physiological reactivity (heightened startle response, slow extinction of
physiological reactions) and consequent trouble modulating the physiological arousal
that comes with trauma.
Tendency to dissociate in the period immediate after the trauma or to become afraid of
the bodily reaction to the shock of the trauma (e.g., rapid heartbeat), with trouble
returning to prior level of functioning quickly (Pynoos, Steinber, & Goenjian, 1996).

within that time. When stress reactions last longer than a month, the cata-
strophic nature of the stress has overwhelmed the child’s resilience, so that
the child cannot restore psychological or biological calm more quickly.
Here, the acute stress disorder becomes a lasting posttraumatic stress dis-
order (PTSD), including dissociation, persistent reexperiencing, avoidance,
and arousal (DSM-IV). PTSD also involves intense psychological distress
and physiological reactivity on exposure to cues that resemble an aspect of
the traumatic event (traumatic reminders). Among children, there is often
a sense of a foreshortened future and a restricted range of affect.
In understanding of trauma and children, there are other kinds of dis-
tinctions. There is simple trauma, but also trauma complicated by grief, as
when a loved one died during a disaster. There is single trauma, or a series of
traumas, each one traumatic itself but also reminding the child of the previ-
ous traumas. A series of traumas can lead to a chronic stress disorder.

Secondary Adversity

After a disaster, children can suffer adversities that are secondary to the
traumatic event. They may undergo medical, surgical, or rehabilitative
treatment; relocation or resettlement; change in caretaking; a drop in
family finances; worsening of school performance; unwanted questions