The emotional response of children in a disaster※ Source: National Welfare Foundation for Disabled Children (social welfare service corporation), Child
Care Support Information Magazine, No. 19, 8-13, 2017Child Psychological Symptoms in Emergency Situation
Naru Fukuchi – Director, Doctor
Research and Planning Division, Stem Center, MDMHCC

Introduction
In the Great East Japan earthquake that struck the Tohoku region on March 11, 2011, approximately
400,000 people used shelters, many of whom had special needs, including children and people withdisabilities. Over time, the evacuation center moved from the shelter to temporary housing; children reacted
in a variety of ways, and support was carried out in an ad hoc manner1, 2, 3. In thinking about how to care forchildren in a disaster, it is most important to keep in mind that symptoms differ according to the child’sdevelopmental age (Table 1) 4. The purpose of this paper is to create a report for families and supporters so
as to minimize confusion in the event of a disaster of a similar scale in the future.
In general, infants are sensitive to changes in the environment, and they are prone to tears and symptoms
such as not sleeping. Puberty is a time when children have the ability to accurately recognize what ishappening to them and show a reaction that is analogous to that of an adult. When there is a deviation indevelopment, there is first maladjustment due to hypersensitivity, and later behavior with inadequate
understanding of an event may also be observed.

Psychological response in a disaster1. Acute phase reaction
The acute phase is generally a period of several months following a disaster. During this time, there aremany reflective physiological reactions associated with the strong impact of this experience. Most of thesereactions are temporary and can be regarded as normal reactions to abnormal situations, and a sense of
security can be achieved in a few months.

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1) Physical symptoms
At an age when it is difficult to express the inside of the chest in words, the conflict may appear asa variety of bodily symptoms.5 Symptoms are often related to sleep (insomnia, night cry, evening
terrors), discharge (night urine, frequent urination), gastrointestinal symptoms (diarrhea, abdominal pain,
nausea), etc. In particular, insomnia associated with hypersensitivity is often seen in handicappedchildren, and temporary medication may be necessary in severe cases. Further, there is a deteriorationfrom the previous disease, such as bronchial edge breath and preparative skin dermatitis.
2) Regression
Regression is a return to infancy; in a sense, it is a phenomenon in which a child who has a scaryand painful experience turns back in the growth process. It uses baby talk, hugs its parents, hates thedark, and does not want to be alone. Because this is usually a temporary reaction, it is important forparents to watch children without upsetting them. It is not recommended that parents accept children’s
requests without limitation.
3) Elevated moodSome children can be observed immediately after a disaster to be in an elevated mood and to havea hurried demeanor. Their voices and movements may be more pronounced than usual, they may be
irritable, and they may be unusually sensitive to stimulation from the surrounding environment. Thesephenomena can be thought of as a normal response from the nervous system to protect oneself andprepare for unforeseen circumstances. If this behavior continues long after the crisis has passed, it will
become a major obstacle in life. If it leads to destructive or deviant behavior, adults must exert control
and set clear rules.

4) Pretend play
Flashbacks expressed as pretend play show that painful experience is stored in the memory withall senses. If a child is old enough to develop language skills, he can express his discomfort in words
and organize his experiences and memories by listening to the adults around him. On the other hand, if
the child at his age does not yet have language ability, he will reproduce his experiences through playrather than in words. Immediately after the Great East Japan Earthquake, we frequently observed such
earthquake and tsunami play.. This behavior need not be restrained unless it far exceeds normalboundaries; it usually decreases over time.
2. Mid- to long-term response
When more than half a year has passed since a disaster, reconstruction of the residential area will begin
and the adults in the child’s world will regain their sense of calm. With the passage of time, children’s－ 142－

The emotional response of children in a disastercognitive abilities develop so that they can gradually begin to understand what has happened to them, andreactions associated with their current awareness are observed.
1) Attention seeking
A child who at first may have reacted patiently to the disaster may have a different reaction once
the adults have calmed down. Behavior is observed that draws the attention of adults in various ways.
Especially if a child has a younger sibling, he may start to compete for his parents’ attention. He may
regress in time, lie, or yell, or he may do the opposite and try to curry favor.
2) Impulsivity
With rapid cognitive development, a child gradually realizes the magnitude of what she has
experienced. There may be feelings of uneasiness due to not knowing when a similar event might occur,and the child may become unable to cherish the present moment or act with a view of the future. The
child might spend his or her pocket money immediately and behave impulsively in other ways, such as
overeating. At home, this may lead to a backlash against parents, or toward other children at school. It isnecessary to keep excessive behavior in check.
3) Various symptoms of anxiety
The symptoms exhibited during this period are often not directly linked to the disaster, and it isdifficult for adults around children to understand their behavior in relation to the disaster. Many of thesechildren have long carried feelings of anxiety and fear that they felt at the time without being able toprocess them. Confirming the presence of their belongings, feeling that they are disliked by thosearound them, and general anxiety such as being frightened of people are all expressions of these
emotions. Children may fear death and be afraid to go to sleep. Adults should listen to children’s
experiences at the time of the disaster in detail and imagine the events from the eyes of the child and the
feelings they provoked; individual specialized responses are necessary.
4) Symptoms of depression
Depression symptoms may indicate a condition similar to that of adults, without appearing as
behavioral problems or anxiety; a child may be apathetic or have lowered concentration, experience a
decline of interest in favorite things, experience fatigue, or develop insomnia. In many cases, it isnecessary to pay attention to these factors because they may lead to poor school attendance. Losses as aresult of a disaster (relatives, friends, important things, communities, schools, etc.) may still be felt, andit can be difficult to explain one’s inner feelings in words in an interview. Medication is sometimes
required. It is hoped that supporters and families will cooperate to support each child under the guidanceof a specialist, recommending adequate rest without overdoing things.

Cases of children with developmental disabilities
A characteristic reaction was also observed in children with developmental disabilities. We present
three examples; some details have been changed to protect their anonymity.
1. Case 1
A 12-year-old boy was diagnosed with autism and was hospitalized at a medical institution. Throughout
his childhood, he had been sensitive to sound, and often, he would panic and cover his ears. After he enteredschool, he found it difficult to adapt to the group. He was bullied, and his attendance was irregular. At home,
he was immersed in games and his computer.
Although he did not live in the area where the tsunami had reached, it was difficult for him to live at
home. He took refuge in a neighboring elementary school gymnasium, but it was noisy, and even securing aplace to sleep was difficult. He would lie on his futon and try to block out the sounds, but after a while, hebegan to walk round and round and was unable to remain in the gymnasium. He occupied a game unit that
had been stored there and sat in it 24 hours a day. When he moved to a welfare shelter for elderly and thosewith disabilities, he gradually became calm.
2. Case 2
A 9-year-old girl had been involved in a rehabilitation agency as a child with autism and intellectual
disabilities. She was deeply attached to her belongings, ate using only certain dishes, decided in advance
what to wear for each day of the week, and had a special set of belongings for when she went out. She rarely143

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got upset or panicked, and unless a promise was broken, she did not have difficulty dealing with her
surroundings.
During the earthquake, the tsunami reached her home. She evacuated to a nearby hill with her family
and silently watched as her home and town were destroyed in the tsunami. Although the family was moved
to an evacuation shelter, they decided to relocate to the relatively undamaged home of the child’s
grandparents. A few days later, she arranged her favorite things around her in an orderly fashion, and before
she went to bed, she began to check their numbers and positions repeatedly. Additionally, she refused tothrow away empty candy bags and the like, and the family eventually stopped shouting at her to do so. Thisaction continued for some time after leaving the shelter, but as school resumed and life stabilized, it becameless frequent.
3. Case 3
A 10-year-old boy went to a medical institution with a diagnosis of attention deficit hyperactivity
disorder (ADHD). He had strong hyperactivity and impulsiveness; he often got lost and was constantly
getting into trouble at school with his classmates. He was treated at specialized medical institutions, where
he received both support and medication. On holidays, he took lessons with his father. His family
relationships were peaceful, and he liked to write.
During the earthquake, the tsunami reached his home, but he did not witness it because his family
evacuated early. Fearing the effects of radiation, his family was forced to relocate and live in a different
prefecture. After the evacuation, the boy began to go on tirades and express violent behavior toward his
mother and siblings. He was also not sleeping enough. He was verbally and physically disruptive at school
and did not follow the teacher’s instructions. He also got into trouble with his classmates. As a result ofmajor adjustments to a regimen of antipsychotic drugs, by the time he participated in the local memorial
festival in his home community, his violent words and actions had diminished.

How to respond
It is necessary to consider the unique characteristics of each child. We provide appropriate support inconsideration of the child’s developmental age and inclination, experience at the time of the disaster, andlife situation since that time, and of how much time has passed since the disaster.
1. Providing a sense of security
The first priority is to provide a sense of security. Although the physical security of the evacuation
shelter as well as food, clothing, and basic needs are crucial, it is important for children to feel safe andclose together. This can also offer them a sense of security to discuss and prepare for how to respond in theevent of a similar disaster. Evacuation training immediately after the disaster was avoided based on adults’consideration of the situation, but children’s anxiety was reduced by actively participating in disasterprevention activities.
2. Returning to everyday life
The rhythm of everyday life can be disrupted by a disaster. Eating three meals each day, ensuring areasonable amount of sleep, and spending time with friends and teachers helps provide mental and physicalstability. Further, it is important to return to daily social activities such as clubs and lessons. Children with
developmental disorders tend to immerse themselves in their favorite things, such as games, and it may benecessary to reconfigure the existing patterns of daily life.6
3. Imparting accurate knowledge
Out of a desire to avoid exacerbating a child’s grieving, adults may not provide accurate knowledge
concerning a disaster. As is appropriate for the age of the child, however, it is important to be clear about thefacts surrounding a disaster and to prevent unnecessary anxiety about future possible disasters and losses offamily or friends. Additionally, after a painful experience, it is possible to teach children coping
mechanisms that can help prevent mental health symptoms. Results have been reported concerning this topic
and about what can be done on a daily basis.7

Things that can be done on a daily basis
1. Connection with local community in ordinary times－ 144－

The emotional response of children in a disasterIn hearing from families that foster children with developmental disabilities, we can discern theimportance of connection with the community. When a child’s developmental disorder is mild, the family
may not willingly reveal that information. However, this can change in a crisis, and it is important to realize
its importance during ordinary times. Children with disabilities who are living in a community should be
provided with necessary support in ordinary peaceful times. In fact, the number of people wishing to takeadvantage of welfare services such as afterschool programs after the earthquake has increased, and this canbe seen as a positive change. Various family associations and social media tools such as Twitter andFacebook (social networking services, SNS) have also been reported to be useful as sources of connection to
the community.
2. Importance of support
A “support book” is a record of information concerning people who have a variety of disabilities that
communicate their characteristics and symptoms. Many children with developmental disabilities receive
daily medical treatment from their family physicians, who already have information about their personal
histories and characteristics. Children who are not accustomed to life after an earthquake, however, canundergo physical symptoms such as loss of appetite or nausea. In such a situation, these children may not beable to see their family physicians and are less likely to consult a temporary physician. The “support book”
gives a new doctor necessary information to allow for a smooth examination process.
3. Knowledge about the mental health care teamDuring the Great East Japan Earthquake, the Ministry of Health, Labour, and Welfare dispatched amental health care team in response to a request from the affected municipalities. This team was composedof psychiatrists, nurses, mental health workers, clinical psychologists, administrators, and others. They
cooperated with the activities of community health nurses and visited disaster-stricken homes. The teamfocuses on care for children and provides necessary consultations, prescriptions, and the like, and mayconnect residents to local specialty medical institutions when necessary. The experience of the earthquake
necessitated special support for children, including child psychiatrists, and the team was dispatched manytimes. Because similar support is assumed for similar disasters in the future, it is useful in the case of an
emergency to know that such a consultation team exists.

Conclusion
Needless to say, a “support book” is useful for children with various health issues; in the case of adisaster, many unforeseen events can arise. When a disaster of this scale occurs, normal organizational
structures are destroyed, and it takes time for a community to regain its mental equilibrium. The best
approach to disaster prevention is to create a wide variety of connections beginning in ordinary daily life
and to build a local community that will be strong in the face of any disaster that might occur.

References
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5) Shinichiro N. Symptoms frequently seen in children. Kazumi F, Masaharu M (eds.): Major disasters andchildren’s stress, first edition, Seishin Shobo, Tokyo, pp. 24-27, 2011.
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Traumatic Stress, 10:11-16, 2012.
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