Mental Responses to Disaster Events and How to Address ThemMDMHCC
Naru Fukuchi
Introduction
As a result of the Great East Japan Earthquake that struck the Tohoku region on March 11, 2011,about 400,000 people used evacuation centers, including many with special needs, such as children
and people with disabilities. With the passage of time, evacuation sites were moved from shelters totemporary housing; children responded in various ways to this turmoil, and a variety of touch-and-go
support measures were implemented 1-3). The purpose of this paper is to report these responses so thatthey may serve as clues to enable us to provide prompt support in the event of future large-scaledisasters.
When considering the mental care of a child in the event of a disaster, it is necessary to keep inmind that symptoms will differ depending on developmental age (Table 1) 4). In general, infants are
sensitive to changes in the environment and may have symptoms such as crying and sleeplessness.
Adolescents are at an age where they are beginning to be able to accurately recognize what ishappening to them and may respond in an adult-like manner. However, between infancy andadolescence, that is, the elementary school ages, children often exhibit various reactions. Supporters
around them must work directly with the child, and at the same time, must also play a role in reducing
parents’ anxiety by presenting specific measures.
Table 1: Responses of Children to Disasters and Appropriate Interventions
AgePreschool
1–5 years

Behavior
・Bedwetting,thumb-Sucking
・Clinging to parents
・Fear of the dark・Inability to sleep
alone
・Cries easily

Childhood
6–11 years

・Decreased
learning ability
・Aggressive
behavior at homeor school・Hyperactivity or
flippant attitude
・Infantile crying

Physical Symptoms
・Loss of appetite

Emotions
・Anxiety

・Stomach pain

・Fear・Nausea

・Irritation

・Sleep disorders/night terrors
・Difficulty
conversing
・Tics

・Angryoutbursts
・Loneliness・Changes inappetite・Headaches

・School refusal

・Stomach pain・Sleep disorders/night terrors

・Getting into
conflicts withyounger siblings to
draw theirparents’attention- 107 -

・Withdrawal

・Avoidance ofInteraction
with friends
and family・Angryoutbursts
・Immersion in
behaviors in
response toextreme
disasters orsafetyIntervention methods
・Use calming language ordemonstrate relaxing behavior
・Enact relaxing patterns before bed
・Avoid unnecessary separation
・Allow them to sleep with theirparents every once in a while
・Encourage them to re-enact
experiences of loss・Avoid exposure to media, news,etc.
・Encourage them to express
themselves through play・Watch over and care for themmore than usual・Temporarily reduce what is askedof them at home and school・Respond calmly to instances ofacting out, set firm rules
・Give them fair roles at home
・Encourage them to express theirthoughts and feelings throughwords or play・Listen calmly to their repeatedretellings of disaster experiences
・Prepare disaster kits, etc., withthe child・Rehearse safety measures for
future disasters
・Enact measures in schools(mutual support, activities forexpressing emotions, disastereducation, planning,Youngadulthood
12–18 years

・Decreased learning
ability・Rebelliousness athome or school・Irresponsibility
・Worrying,
Decreased
initiative, lethargy
・Laziness
・Social withdrawal(shut-in)

・Changes inappetite
・Headaches
・Digestive
symptoms
・Rashes・Vague complaints
ofpain・Sleep disorders/night terrors

・Loss of interest
in social
behaviors withfriends,
hobbies, andrecreation
・Sadness anddepression
・Defiance ofauthority
・Feelings ofmaladjustmentorpowerlessness

identification of high-riskchildren)
・Watch over and care for themmore than usual・Temporarily reduce what is askedof them at home and school・Allow them to speak about thedisaster with friends or adults theytrust
・Recommend reasonable physicalactivities
・Rehearse safety measures for
future disasters
・Encourage them to return to socialand physical activities and lessons
that they used to take part in・Encourage participation incommunity reconstruction
activities, and give them roles
・Enact measures in schools(mutual support, activities forexpressing emotions, disastereducation, planning,
identification of high-riskchildren)

1. Acute Phase Responses
Focusing on the elementary school age, which is likely to be addressed in pediatric clinicalpractice, I will describe the reactions seen in the months immediately following the disaster. During
this period, there are many physiological reactions associated with high-impact traumatic
experiences.
(1) Physical Symptoms
When children are at an age at which it is difficult for them to express in words what is in
their heart, their internal conflict may appear as various physical symptoms 5). Frequent
symptoms include those related to sleep (crying at night, night terrors), excretion (bedwetting,pollakiuria), and digestion (diarrhea, abdominal pain, nausea). In addition, pre-existing
conditions such as bronchial asthma and atopic dermatitis may be exacerbated. These responses
can be understood broadly as psychosomatic disorders, and it is recommended that children withthese symptoms see a pediatrician for physical illnesses.
(2) Regression
Regression is, so to speak, a return to an infantile state. A phenomenon commonly observedin pediatric clinical practice, it involves a child who has had a scary or painful experience
seeming to “grow down.” Manifestations include baby talk, clinging to parents, avoiding darkplaces, and being unable to be alone. Since this is usually a temporary reaction, it is importantfor parents to be watchful without being upset. Supporting adults should be told that this is “notan abnormal reaction, but rather a normal reaction to an abnormal event.”(3) Elevated mood
Immediately after a disaster, children may exhibit a persistently elevated mood. They speak
loudly, move broadly, anger easily, and are quite sensitive to stimuli around them. You can thinkof this as a normal reaction to heighten one’s nerves to protect oneself and prepare for unforeseen
circumstances. If it continues for a long time after the crisis has passed, it will cause a big
hindrance to life. If it leads children to engage in destructive deviant behavior, it is desirable for
adults to control and set certain rules in their lives.
(4) Playmaking
This simply refers to what is commonly known as a “flashback,” where a traumatic
experience is replayed in one’s memories, along with all the associated sensations. If the childin question is at an age at which they will have developed sufficient linguistic ability to do so,they will usually express their discomfort verbally and ask adults around them to listen to what
- 108 -

they have to say, thereby addressing the issue. On the contrary, younger children will recreate
their experience through what is known as posttraumatic play. Posttraumatic play is a symptom
in which a child who has undergone a traumatic experience will repeatedly re-enact thatexperience in play. After the disaster, I saw many children playing “earthquake games,”“tsunami games,” and “evacuation games.” If any adults that children naturally gravitate toward
are around, they should make an effort to ensure that the game has a “happy ending.” As longas the play does not involve any gross deviations, there is no need to limit or stop it. Thisplaymaking usually subsides with time.
2. Medium- to Long-Term Responses
More than half a year has passed since disaster; the reconstruction of residential areas has begun
little by little, and adults have started to regain their composure. Regarding children, as their
cognitive abilities develop and they gradually become able to understand what happened to them,this realization elicits its own set of responses.
(1) WarinessChildren who were lonely but patient at the beginning of the disaster may react when adults
calm down. There are various behaviors that attract the attention of adults. Especially when there
are younger siblings, they try to get the attention of their parents by competing or fighting withthem. They may show regression at different times, do things to deliberately get themselvesscolded, such as lying or engaging in violence, or, conversely, may fawn over adults, offering
incessant help. If the adults around such children do not understand the psychology underlying
these responses, their relationship with the children may be disturbed; therefore, it is importantthat they receive objective feedback on the phenomena that are occurring.
(2) Impulsive, Reckless Behavior
As their cognitive capacity rapidly develops, these children may gradually recognize theimportance of what they have experienced. Once beset by the feeling that a similar catastrophe
could occur anytime, anywhere, children become unable to cherish the “now,” and likewise
become unable to engage in purposeful, predictive behavior. These children will use up theirpocket money immediately, do only what they like, and hog food, unable to give consideration
to others. These irresponsible actions that are not suitable for their age may be interpreted as
rebellious behavior. At home, it may lead to opposition to parents, and at school, to trouble withother children. Strong boundaries are required for deviant behavior. However, it is necessary to
encourage children to express their underlying traumatic experiences and to empathize withthem.
(3) Varied Anxiety Symptoms
Symptoms that surface during this period are often not directly linked to the disaster, and it
is difficult for adults around them to understand the behavior of their children. Many of thesechildren are unable to handle the anxiety and fear they felt at the time, and often carry it withthem for a long time. They may develop a habit of checking their belongings or have a damaging
sensation of being disliked by others. Their emotions may also surface as general anxiety,including a fear of people. In addition, if they are holding on to a fear of death, they may exhibit
anxiety related to falling asleep. It may be necessary to listen in detail to the situation at the timeof the disaster from the adults around, imagine the events and emotions that occurred from theperspective of the child, and take specialized individual measures.
(4) Depressive Symptoms
Adult-like depressive states may occur when acting out proves impossible and anxiety cannot
be expressed. These symptoms may include lethargy, poor concentration, diminished interest inotherwise enjoyable things/activities, tiredness, and insomnia. In many cases, it is accompaniedby truancy, which may lead to poor academic performance; this necessitates caution. If there isa feeling of loss (of relatives, friends, important things, community, school, etc.) due to thedisaster, it can be hard for children to explain themselves in words even if spoken to, andmedication may be necessary. It is desirable to recommend rest without forcing, and to cooperatewith surrounding supporters and family members under the guidance of a specialist.
3. Addressing These Responses- 109 -

When responding to these behaviors, it is necessary to consider the characteristics of each child.
We must provide appropriate support after taking into account the child’s developmental age anddevelopmental biases, experience at the time of the disaster, background of life after the disaster,and time since the disaster.
(1) Providing a Sense of Safety
The first priority is to provide a sense of security. It is natural to have a sense of security inevacuation areas with regard to food, clothes, and so on, but it is important for adults who theaffected child can feel at ease with to be close to them. Also, discussing and preparing for asimilar disaster can be reassuring. Evacuation drills immediately after a disaster are often
avoided out of consideration for adults, but some children can become less anxious by actively
participating in such activities.
(2) Regaining a Sense of Normalcy
In many cases, life is completely changed by a disaster and the existing rhythm is disturbed.
Eating three meals a day, getting adequate sleep, and spending time with familiar friends andteachers can help stabilize the mind and body. Furthermore, it is important to resume the daily
routine of social activities such as playtime and lessons. Children with developmental biases
tend to immerse themselves in what they like, such as games, and existing rules may need to bereconfigured to account for these tendencies 6).
(3) Providing Accurate Knowledge
To avoid upsetting a child, we may sometimes refrain from providing them with accurate
knowledge about disasters. Teaching the mechanism of disasters according to the child’sdevelopmental age and explaining the death of family and friends helps prevent unnecessary
anxiety. In addition, teaching the psychological reaction that occurs after a traumatic experienceand how to deal with it has been reported to lead to the prevention of post-hoc psychiatric
symptoms 7).
4. Use of Mental Health Care Teams
After the Great East Japan Earthquake, the Ministry of Health, Labour, and Welfare coordinatedthe dispatch of mental care teams at the request of affected municipalities 8). These teams werecomposed of psychiatrists, nurses, psychiatric social workers, clinical psychologists, and clerks, andin cooperation with community health nurses, patrolled shelters and visited disaster-stricken houses.
Children who were confused were also taken care of, received the necessary consultations andprescriptions, and were referred to local specialized medical institutions when necessary. As a resultof the experience of the Great Hanshin-Awaji Earthquake, the need for support for children wasanticipated, and child psychiatrists formed a part of mental health teams. Since a need for similar
support is expected in future disasters, professionals who may be involved in supporting children in
an emergency need to be aware of the existence of this possible point of contact.
Conclusion
It goes without saying that preparation is useful in the event of a disaster, but not all eventualities
can be anticipated. When a disaster of the scale of the Great East Japan Earthquake occurs, theorganization that manages the community itself will be destroyed, and it will take time to restore
normal community mental health. It can be said that the best disaster prevention is to construct a
network of professionals during peacetime itself and to build a disaster-resistant community.
Key points① Keep in mind that symptoms will differ based on the developmental age of the child in question.
② Efforts that provide children with a sense of security and a return to normalcy are most important.
③ Inform professionals that mental health care teams can serve as a consultation point of contact.
(Published in Pediatric Medicine, Vol. 45, No. 8, Aug. 2013)

References- 110 -1) Naru Fukuchi, Mizuho Hayashi: The current state of mind of children in the disaster area. Children’s Spirit and Nerves 51: 126–132, 2011.
2) Naru Fukuchi: What the earthquake gave to the child-rearing environment. Child Abuse andNeglect 14: 14–19, 2012.
3) Naru Fukuchi: Earthquake and children’s growth. Growth’s Science 18: 74–78, 2012.
4) Deborah JD: Disaster reactions of potential risk groups. Diana N (ed.): Training Manual for
Human Service Workers in Major Disasters, 2nd ed, National Institute of Mental Health, Washington, D.C., pp 17–30, 2000.
5) Shinichiro Nagamitsu: Physical symptoms that are likely to be seen in children. KazumiFujimori, Masaharu Maeda ed.: Catastrophe and stress in children, Seishin Shobo, Tokyo, pp24–27, 2011.
6) Naru Fukuchi: Support for children with developmental disabilities in the event of a disaster.
Junichi Furusho ed.: Advances in medicine for developmental disabilities 25, Diagnosis andTreatment Company, Tokyo, pp 36–41, 2013.
7) Yoshiki Tominaga, Mitsuko Miura, Sho Yamamoto, etc.: Support class for children’s minds
after a large-scale disaster. Traumatic Stress 10: 11–16, 2012.
8) Hiroshi Kuwahara: From the activities of the Kanagawa mental care team. Traumatic Stress 10:
17–21, 2012.

- 111 -