Children's Cognitive Functioning in Disasters and Terrorism.

A growing literature has begun to address the cognitions that influence children's disaster reactions as well as the effects of disasters on children's cognitions. These cognitions must be viewed in the context of developmental and cultural considerations as well as disaster-related factors such as exposure and secondary stressors. This review examines the extant literature on children's cognitions related to disasters and terrorism including threat appraisal, beliefs, attention and concentration, memory, academic achievement, and executive functioning. The review highlights areas where research is lacking such as the effect of disasters on children's attention, concentration, content of disaster memories, and executive functioning. It also notes findings that may advance post-disaster screening and intervention.

Review of Coping in Children Exposed to Mass Trauma: Measurement Tools, Coping Styles, and Clinical Implications.

Evidence-based practice requires the use of data grounded in theory with clear conceptualization and reliable and valid measurement. Unfortunately, developing a knowledge base regarding children's coping in the context of disasters, terrorism, and war has been hampered by a lack of theoretical consensus and a virtual absence of rigorous test construction, implementation, and evaluation. This report presents a comprehensive review of measurement tools assessing child and adolescent coping in the aftermath of mass trauma, with a particular emphasis on coping dimensions identified through factor analytic procedures. Coping measurement and issues related to the assessment of coping are reviewed. Concepts important in instrument development and psychometric features of coping measures used in disasters, terrorism, and war are presented. The relationships between coping dimensions and both youth characteristics and clinical outcomes also are presented. A discussion of the reviewed findings highlights the difficulty clinicians may experience when trying to integrate the inconsistencies in coping dimensions across studies. Incorporating the need for multiple informants and the difference between general and context-specific coping measures suggests the importance of a multilevel, theoretical conceptualization of coping and thus, the use of more advanced statistical measures. Attention also is given to issues deemed important for further exploration in child disaster coping research.

Child disaster mental health interventions: therapy components.

Children face innumerable challenges following exposure to disasters. To address trauma sequelae, researchers and clinicians have developed a variety of mental health interventions. While the overall effectiveness of multiple interventions has been examined, few studies have focused on the individual components of these interventions. As a preliminary step to advancing intervention development and research, this literature review identifies and describes nine common components that comprise child disaster mental health interventions. This review concluded that future research should clearly define the constituent components included in available interventions. This will require that future studies dismantle interventions to examine the effectiveness of specific components and identify common therapeutic elements. Issues related to populations studied (eg, disaster exposure, demographic and cultural influences) and to intervention delivery (eg, timing and optimal sequencing of components) also warrant attention.

Children's Coping in the Context of Disasters and Terrorism.

Disasters and terrorism present significant and often overwhelming challenges for children and families worldwide. Individual, family, and social factors influence disaster reactions and the diverse ways in which children cope. This article links conceptualizations of stress and coping to empirical knowledge of children's disaster reactions, identifies limitations in our current understanding, and suggests areas for future study of disaster coping. Coping strategies, developmental trajectories influencing coping, and the interplay between parent and child coping represent critical areas for advancing the field and for informing programs and services that benefit children's preparedness and foster resilience in the face of mass trauma.

Child disaster mental health interventions, part II: Timing of implementation, delivery settings and providers, and therapeutic approaches.

This review summarizes current knowledge on the timing of child disaster mental health intervention delivery, the settings for intervention delivery, the expertise of providers, and therapeutic approaches. Studies have been conducted on interventions delivered during all phases of disaster management from pre event through many months post event. Many interventions were administered in schools which offer access to large numbers of children. Providers included mental health professionals and school personnel. Studies described individual and group interventions, some with parent involvement. The next generation of interventions and studies should be based on an empirical analysis of a number of key areas.

Child disaster mental health interventions, part I: Techniques, outcomes, and methodological considerations.

This review of child disaster mental health intervention studies describes the techniques used in the interventions and the outcomes addressed, and it provides a preliminary evaluation of the field. The interventions reviewed here used a variety of strategies such as cognitive behavioral approaches, exposure and narrative techniques, relaxation, coping skill development, social support, psychoeducation, eye movement desensitization and reprocessing, and debriefing. A diagnosis of posttraumatic stress disorder (PTSD) and/or posttraumatic stress reactions were the most commonly addressed outcomes although other reactions such as depression, anxiety, behavior problems, fear, and/or traumatic grief also were examined. Recommendations for future research are outlined.

Research Methods in Child Disaster Studies: A Review of Studies Generated by the September 11, 2001, Terrorist Attacks; the 2004 Indian Ocean Tsunami; and Hurricane Katrina.

BACKGROUND: A comprehensive review of the design principles and methodological approaches that have been used to make inferences from the research on disasters in children is needed. OBJECTIVE: To identify the methodological approaches used to study children's reactions to three recent major disasters-the September 11, 2001, attacks; the 2004 Indian Ocean Tsunami; and Hurricane Katrina. METHODS: This review was guided by a systematic literature search. RESULTS: A total of 165 unduplicated empirical reports were generated by the search and examined for this review. This included 83 references on September 11, 29 on the 2004 Tsunami, and 53 on Hurricane Katrina. CONCLUSIONS: A diversity of methods has been brought to bear in understanding children's reactions to disasters. While cross-sectional studies predominate, pre-event data for some investigations emerged from archival data and data from studies examining non-disaster topics. The nature and extent of the influence of risk and protective variables beyond disaster exposure are not fully understood due, in part, to limitations in the study designs used in the extant research. Advancing an understanding of the roles of exposure and various individual, family, and social factors depends upon the extent to which measures and assessment techniques are valid and reliable, as well as on data sources and data collection designs. Comprehensive assessments that extend beyond questionnaires and checklists to include interviews and cognitive and biological measures to elucidate the negative and positive effects of disasters on children also may improve the knowledge base.

The burden of disaster: Part I. Challenges and opportunities within a child's social ecology.

Child development and adaptation are best understood as biological and psychological individual processes occurring within the context of interconnecting groups, systems, and communities which, along with family, constitute the child's social ecology. This first of two articles describes the challenges and opportunities within a child's social ecology consisting of Micro-, Meso-, Exo-, and Macrosystems. The parent-child relationship, the most salient Microsystem influence in children's lives, plays an influential role in children's reactions to and recovery from disasters. Children, parents, and other adults participate in Mesosystem activities at schools and faith-based organizations. The Exosystem--including workplaces, social agencies, neighborhood, and mass media--directly affects important adults in children's lives. The Macrosystem affects disaster response and recovery indirectly through intangible cultural, social, economic, and political structures and processes. Children's responses to adversity occur in the context of these dynamically interconnected and interdependent nested environments, all of which endure the burden of disaster Increased understanding of the influences of and the relationships between key components contributes to recovery and rebuilding efforts, limiting disruption to the child and his or her social ecology A companion article (R. L. Pfefferbaum et al., in press) describes interventions across the child's social ecology.

Framework for research on children's reactions to disasters and terrorist events.

Clinical work and research relative to child mental health during and following disaster are especially challenging due to the complex child maturational processes and family and social contexts of children's lives. The effects of disasters and terrorist events on children and adolescents necessitate diligent and responsible preparation and implementation of research endeavors. Disasters present numerous practical and methodological barriers that may influence the selection of participants, timing of assessments, and constructs being investigated. This article describes an efficient approach to guide both novice and experienced researchers as they prepare to conduct disaster research involving children. The approach is based on five fundamental research questions: "Why?, Who?, When?, What?, and How?" Addressing each of the "four Ws" will assist researchers in determining "How" to construct and implement a study from start to finish. A simple diagram of the five questions guides the reader through the components involved in studying children's reactions to disasters. The use of this approach is illustrated with examples from disaster mental health studies in children, thus simultaneously providing a review of the literature.

Issues in the assessment of children's coping in the context of mass trauma.

Exposure to mass trauma has contributed to increasing concern about the well-being of children, families, and communities. In spite of global awareness of the dramatic impact of mass trauma on youth, little is known about how children and adolescents cope with and adapt to disasters and terrorism. While coping has yet to be fully conceptualized as a unified construct, the process of responding to stress includes recognized cognitive, emotional, and behavioral components. Unfortunately, research on the complex process of adaptation in the aftermath of mass trauma is a relatively recent focus. Further study is needed to build consensus in terminology, theory, methods, and assessment techniques to assist researchers and clinicians in measuring children's coping, both generally and within the context of mass trauma. Advancements are needed in the area of coping assessment to identify internal and external factors affecting children's stress responses. Additionally, enhanced understanding of children's disaster coping can inform the development of prevention and intervention programs to promote resilience in the aftermath of traumatic events. This article examines the theoretical and practical issues in assessing coping in children exposed to mass trauma, and includes recommendations to guide assessment and research of children's coping within this specialized context.

The burden of disaster: part II. applying interventions across the child's social ecology.

This second of two articles describes the application of disaster mental health interventions within the context of the childs social ecology consisting of the Micro-, Meso-, Exo-, and Macrosystems. Microsystem interventions involving parents, siblings, and close friends include family preparedness planning andpractice, psychoeducation, role modeling, emotional support, and redirection. Mesosystem interventions provided by schools and faith-based organizations include safety and support, assessment, referral, and counseling. Exosystem interventions include those provided through community-based mental health programs, healthcare organizations, the workplace, the media, local volunteer disaster organizations, and other local organizations. Efforts to build community resilience to disasters are likely to have influence through the Exosystem. The Macrosystem - including the laws, history, cultural and subcultural characteristics, and economic and social conditions that underlie the other systems - affects the child indirectly through public policies and disaster programs and services that become available in the child's Exosystem in the aftermath of a disaster The social ecology paradigm, described more fully in a companion article (Noffsinger Pfefferbaum, Pfefferbaum, Sherrieb, & Norris,2012), emphasizes relationships among systems and can guide the development and delivery of services embedded in naturally-occurring structures in the child's environment.