# Children's Mental Health in the Aftermath of Disaster - Expert Perspectives and Critical Next Steps
## Session Chair: Jonathan S. Comer, PhD, Florida International University

Disasters are destructive occurrences that disrupt and overwhelm entire communities, confront every society, and affect millions worldwide in a given year. There is evidence that the incidence of disasters may be increasing, and when disasters strike, a great many children and adolescents are in close proximity and are vulnerable to directly witnessing massive destruction, seeing dead or injured people, being involved in a school evacuation, losing a loved one, viewing physical damage or ruins, and/or being forced to relocate residency. Such diverse phenomena as hurricanes, earthquakes, floods, tsunamis, brushfires, terrorist attacks, mass transportation disasters, and nuclear waste accidents are associated with elevated rates of psychopathology and impairment in children and adolescents. Indirect exposure to disasters can also prompt a host of negative symptoms in youth. Importantly, there is considerable heterogeneity across youth outcomes following disasters, and a complex interplay among key factors related to the child, the child's predisaster experiences, the nature of the child􀂶s disaster exposure, and the postdisaster recovery environment influences child postdisaster risk and resilience.
For this symposium, a panel of leading experts will share data and perspectives drawn from years of focused research on children and adolescents affected by disasters. First, Dr. Annette La Greca will share her pioneering work examining patterns and predictors of risk and resilience among children affected by hurricanes. Dr. Comer will present recent findings from his work studying mental health outcomes among youth directly and indirectly exposed to terrorism. Dr. Lochman will present 3-year follow-up data on externalizing and internalizing symptoms in youth exposed to tornadoes, drawing on a rare prospective, longitudinal design. Dr. Weems will present data and perspectives based on his extensive research with children in the aftermath of hurricanes and oil spills. Finally, Dr. Guritch will take a more global perspective and will present on the effects of disasters on youth in developing regions of the world. We will conclude with panelists offering pointed recommendations for where research needs to go in order to optimally inform our understanding of disasters, their effects on youth, and best intervention practices for those at greatest risk.

## What the Study of Post-Hurricane Environments Has Taught Us About Children's Risk and Resilience

Presenter: Annette La Greca, PhD, University of Miami
More than 66.5 million children are affected by natural disasters annually and that number is expected to increase in the coming years due to climate change. Further, children have been identified as a vulnerable population post-disaster. Thus, it is imperative that mental health researchers and practitioners gain an understanding of disasters' impact as well as the factors that predict children's risk, resilience, and recovery. Using multiple studies of hurricanes (e.g., Andrew, Charley, Ike) as a prototype for natural disasters, this presentation will focus on the mental health impact of hurricanes on children. In particular, children's patterns of risk and recovery post-disaster will be reviewed, as well as research on the factors that differentiate between the children who develop chronic post traumatic stress reactions versus those who are resilient or who recover. In general, this research finds that most children are resilient or recover over time, with about 20% displaying chronic distress (i.e., consistently elevated symptoms of posttraumatic stress). Also, compared to those who recover over time, children with higher anxiety, less social support, more intervening life events, and greater use of poor emotion regulation strategies are more likely to be chronically distressed. Effective screening early on after disasters is critical for identifying youth most in need of the limited clinical resources that are available. These findings may provide further guidance on important variables to consider for early screening efforts and for clinical interventions.

#### Notes from session

coming soon!

## Children and Terrorism: Lessons Learned in the Aftermath of the 2013 Boston Marathon Bombing

Presenter: Jonathan S. Comer, PhD, Florida International University
Terrorism - defined in Title 22 of the U.S. Code, Section 2656f(d) as "premeditated, politically motivated violence perpetrated against non-combatant targets by subnational groups... intended to influence an audience" - affects an enormous number of individuals each year. In 2014 alone, there were 13,463 documented terrorist attacks worldwide that resulted in 32,700 deaths, 34,700 injuries, and over 9,400 kidnappings (National Consortium for the Study of Terrorism and Responses to Terrorism, 2016). By definition, the goal of terrorism extends far beyond physical injury and destruction of property. Perpetrators of terrorism induce fear to coerce or intimidate a larger group of persons beyond the immediate victims for the larger objective of attaining political, economic, religious, and/or social change. Indeed, research finds that exposure to terrorism can be associated with a very heavy mental health toll, and children and adolescents are particularly vulnerable to the psychological effects of terrorism. This talk will present recent findings from a large study of Boston-area youth (N=460) in the aftermath of the 2013 Boston Marathon bombing and subsequent manhunt. Data will be presented examining a host of influences that affected Boston-area children's adjustment, including children's direct exposure, children's media-based exposure, caregiver distress, and the critical role of families in helping children process these difficult events. Outcomes assessed included posttraumatic stress symptoms, internalizing psychoathology, and conduct problems. Adjustment in particularly vulnerable populations - such as the families of first responders and law enforcement personnel who participated in the large-scale manhunt - will also be discussed.

#### Notes from session

coming soon!

## Tornado Effects on At-Risk Children's Psychopathology: Role of Psychophysiological Functioning

Presenter: John Lochman, PhD, University of Alabama
In response to severe single-incident traumas such as natural disasters, children may experience behavioral and emotional disruptions due to hypervigilant emotional processing, avoidance behaviors, and reduced perceptions of self competence (Cohen et al, 2000; Foa et al, 1998). Although research has examined the aftereffects of natural disasters such as tornadoes or hurricanes on children, using behavioral data collected after the events (e.g. Vigil et al, 2010), few studies have had pre-disaster data available. Thus, most research has been limited by not knowing how much the disaster changed the children's pre-disaster functioning. In a case where pre-disaster data was available, a recent study of an at-risk sample of aggressive children, has found that exposure to a tornado has led to relatively worse behavioral functioning for those children who had very low pre-disaster parental ratings of anxiety (Lochman et al., in press). To further explore the characteristics of children most susceptible to disaster effects, pre-disaster physiological measures of children's cardiac vagal suppression and skin conductance, as indicators of parasympathetic and sympathetic nervous system functioning, can indicate how children's per-disaster capacities to regulate arousal may interact with their exposure to disaster. The study follows 360 at-risk students who were recruited as 4th graders between 2008 and 2011 in three annual cohorts for an ongoing prevention trial. Children whose scores fell in the top 25% of teacher-rated aggression at 20 schools were identified as potential risk subjects (Gate 1). Children remained eligible if parent ratings met criteria on the BASC Aggression subscale (Gate 2). Sixty-five percent of the children were male, and the sample was 76% Black, 21% White, and 3% "other." Although the tornado had destroyed or damaged 4 schools and many homes of families in the sample, post-tornado data has been collected on 94% of the sample. The data from the three year follow-up after the tornado are presently being cleaned and made ready for analysis, and will include parent and teacher ratings of children's externalizing and internalizing behaviors. The moderators to be examined in these growth model analyses will be children's relative degree of exposure to the tornado (child and parent reports on the Tornado-Related Traumatic Experiences), and their pre-disaster psychophysiological functioning (skin conductance, respiratory sinus arrhythmia) assessed with Biolog during research interviews.

#### Notes from session

coming soon!

## Six Things I've Learned About Disasters and Kids, and Some Things I'd Like to Learn More About

Presenter: Carl Weems, PhD, Iowa State University
This symposium will review data from several studies conducted on diverse samples of youth exposed to hurricanes Katrina and Gustav as well as to the Gulf Oil Spill to highlight 6 key findings. These are: 1. Disasters are typically not good for people - this includes kids;
2. Multiple response trajectories exist, but parsimony-based statistics may not be the best way to identify such diverse trajectories;
3. The dose, what you bring to, and experience after the disaster makes a big difference (A bio-ecological model will be presented); 4. "Resilience" isn't just low response (rates of resilience will be presented);
5. Re-exposure can be bad but is not always bad (particularly if it is just a little second dose - reconsolidation of memories may be a reason why re-exposure is not always bad); and
6. We have procedures that can offer effective interventions following disasters and may help prevent negative long-term consequences.
The talk will conclude with a review of important future questions in disaster research that still need better answers. These include: Does any of what we know now fully apply in developing countries?; What is the nature of heterotypic continuity in disaster response? For example, are there changes in cognition like judgment biases, are these youth more likely to develop existential anxiety or other personality traits; and finally what are the physiological and neural mechanisms responsible for the disaster response in youth?

#### Notes from session

coming soon!

## Not All Disaster Responses Are Created Equal: Children's Needs in Rural and Developing Countries

Presenter: Robin H. Gurwitch, PhD, Duke University Medical Center
It is estimated that nearly 10% of the world's population (over 500 million people) are at risk for displacement due to disasters resulting from climate change. The numbers impacted are increasing at an alarming rate, with a projected increase of more than 50% from just a decade ago. When disasters strike, responses are needed to address issues related to the environment, community, and health/mental health. Unfortunately, not all countries or populations are affected equally. Children are particularly vulnerable around the world, but mental health resources to help vary greatly. In the United States, the APA's Disaster Response Network plays a primary role in helping to meet the mental health needs during and after disasters. In developing countries, mental health professionals are rare. Crisis counselors and other responders addressing mental health care needs in children (and adults) are often community volunteers with no background or education in mental health or related fields. Volunteers may be working on a factory production line one day and providing mental health care services the next. Therefore, training must take these issues into account, providing education and skills grounded in disaster science, while allowing for easy uptake and implementation and recognizing cultural differences. Efforts to address the needs of children following disasters in rural China, American Samoa, and the Philippines will be highlighted as examples of a programmatic approach to international disaster response for children. Recommendations for next steps will be discussed.

#### Notes from session

coming soon!

## Other 2017 Resources

* SCCAP_APA_Convention/2017/Advancements_in_Research_and_Practice_with_Childhood_Externalizing_Problems
* SCCAP_APA_Convention/2017/Children's_Mental_Health_in_the_Aftermath_of_Disaster
* SCCAP_APA_Convention/2017/How_to_Succeed_in_Your_First_Faculty_Job
* SCCAP_APA_Convention/2017/Novel_Approaches_to_Improve_the_Identification_and_Treatment_of_Suicide_Risk
* SCCAP_APA_Convention/2017/The_Adolescent_Brain_Cognitive_Development_Study_(ABCD)
* SCCAP_APA_Convention/2017/Beyond_Empirically_Supported_Treatments–Advances_in_the_Evidence-Based_Practice_of_Psychology