A man is forced to lead his child through dangerous flood waters in Bangkok. File photo: 2011.

By Betty Pfefferbaum and Carol S. North

Implications for Public Health

Parental experience with and reactions to disaster should be considered when addressing children’s responses to extreme events.

Even children who were not directly exposed to a disaster can experience post-traumatic stress, post-traumatic behavior changes, or a drop in grades. Our research found that having a parent who screened positive for a psychiatric disorder after a disaster was one of the biggest factors in predicting a child’s post-disaster symptoms or a decline in school performance—even more significant than whether the child was exposed directly to the disaster.

Our study of 266 children (and 160 of their parents) after three large disasters points to how crucial it is to consider the interplay between a parent's mental health and that of their child. The connection has implications for which children should be screened for additional services after a disaster, as well as how professionals can more broadly plan for and deliver mental health services after disaster.

Implications for Disaster Mental Health Screening

Disaster mental health screening shouldn't be limited to children who were directly exposed to a disaster, but should also consider parents' disaster experiences and reactions, as well as the influence parents have on their child’s reactions and recovery.

Adult survivors should be asked about any children for whom they are caregivers. Questions might explore:

• The child’s disaster exposure and reactions
• The child’s current symptoms and functioning
• The child’s vulnerabilities such as previous trauma and pre-existing conditions
• The availability and quality of family and social support

Because of the relationship between a parent’s reactions and their child’s outcome, it is important to inquire about a range of problems rather than focus exclusively on post-traumatic stress symptoms. Parents may be unaware of important details of their child’s experience and could underestimate their distress. Moreover, the parent’s own experiences and reactions can influence the understanding of their child’s reactions.

Implications for Disaster Mental Health Service Design

Disaster mental health services should include the capacity to provide assessment, referral, and interventions for family members. Because families provide valuable support for children , addressing the disaster reactions of adult survivors can benefit children, even if the children are not the focus of intervention. Given the challenges of providing mental health services post disaster, practitioners should know that treating parent’s disaster reactions, even without a direct focus on children’s symptoms, could benefit children. Of course, this does not eliminate the need to intervene directly with symptomatic children when necessary.

Interventions for children can be delivered to children using individual, group (including school-based), and family approaches. Child interventions commonly include a parent component to provide information, address the parents’ reactions, and offer guidance to help with children’s needs.

In Conclusion

Children rely on their parents for support after disasters, and children and parents react to similar stresses and to each other’s reactions. Thus, the evaluation and support of disaster survivors and their children should consider the family context. Survivors should be asked about their children’s disaster experiences, reactions, and recovery, and assessments of children should consider their parents’ disaster exposure and reactions. By recognizing these interconnections, we can begin to help reduce the suffering that may follow disaster.

Suggested Tools

Helping Children Cope
U.S. Department of Homeland Security
Guidelines for parents to help children cope with disaster, including responses to frequently asked questions about coping at different developmental stages.

Helping Children Cope with Disaster
Federal Emergency Management Agency and American Red Cross
Booklet that offers parents and caregivers suggestions on how to help children cope with the effects of disaster, as well as how to be prepared before a disaster strikes.

Listen, Protect, and Connect: Psychological First for Children and Parents
Federal Emergency Management Agency
Guide designed for families, neighbors, co-workers and first responders to provide psychological first aid after a disaster.

For a list of all the tools included in this special collection, visit the Children and Disasters Tool Index.