Psychological effects of disaster on children and their families

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Psychological effects of disaster on children and their families

Material Information

Title:
Psychological effects of disaster on children and their families Hurricane Hugo and the Loma Prieta earthquake
Series Title:
Quick response research report ;
Creator:
Boore, Judith A
Earle, Gina
Aptekar, Lewis
University of Colorado, Boulder -- Natural Hazards Research and Applications Information Center
Place of Publication:
Boulder, Colo
Publisher:
Natural Hazards Research and Applications Information Center, University of Colorado
Publication Date:
Language:
English
Physical Description:
37 p. : ; 29 cm.

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Subjects / Keywords:
Disasters -- Psychological aspects ( lcsh )
Hurricane Hugo, 1989 -- Psychological aspects ( lcsh )
Loma Prieta Earthquake, Calif., 1989 -- Psychological aspects ( lcsh )
Genre:
government publication (state, provincial, terriorial, dependent) ( marcgt )
bibliography ( marcgt )
non-fiction ( marcgt )

Notes

Bibliography:
Includes bibliographical references (p. 35-37).
General Note:
"July 1990."
Statement of Responsibility:
by Judith A. Boore, Gina Earle, Lewis Aptekar.

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University of South Florida Library
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University of South Florida
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All applicable rights reserved by the source institution and holding location.
Resource Identifier:
001984716 ( ALEPH )
298360640 ( OCLC )
F57-00014 ( USFLDC DOI )
f57.14 ( USFLDC Handle )

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Psychological effects of disaster on children and their families
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f!;yC OF b/s74 I /tAl':"MIL,ES:ANEHutl/)ANb7"ZLOMAJ-Ild.'t4,13ooW'cEa...l-.L&w'.Q"iclcRep'''+#40.:r"y I "t)

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N at.uralHazardsResearchandApplicationsIn{ormationCenterCampusBox482UniversityofColoradoBoulder,Colorado80309PSYCHOLOGICALEFFECTSOFDISASTERONCHILDRENANDTHEIR FAMILIES:HURRICANEHUGOANDTHELOMAPRIETAEARTHQUAKEByJudithA.BooreGinaEarle*LewisAptekarDepartmentofCounselorEducationSanJoseStateUniversity*SanJoseMedicalCenterandStanfordUniversityQUICKRESPONSERESEARCHREPORT #40 July1990.f the Natural Hazards This publicationIS 0Ifrmation Center's ongoing Research & Applications h n Series. .R onse Researc QUIck esp d edu/hazards http://WWW.colorao.TheviewsexpressedinthisreportarethoseoftheauthorsandnotnecessarilythoseoftheNaturalHazardsCenterortheUniversityofColorado.InstituteofBehavioralScience#6 (303)492.6818TELEFAX:(303)492

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PSYCHOLOGICAL EFFECTSOFDISASTERONCHILDRENANDTHEIRFAMILIES:HURRICANEHUGOANDTHELOMAPRIETAEARTHQUAKEJudithA.BooreGinaEarle*LewisAptekarDepartmentofCounselorEducationSanJoseStateUniversity1990QuickResponseReport*SanJoseMedicalCenterandStanfordUniversity

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2PSYCHOLOGICAL EFFECTSOFDISASTERONCHILDREN: HURRICANEHUGOANDTHELOMAPRIETAEARTHQUAKEPURPOSEOFPROJECTThisstudyexplored'therelationshipbetweenresiliencyandpsychopathologyoremotionalreactionofchildrentonaturaldisaster.Itwasalsodesignedtodiscoveranyhithertounknownchildandfamilyresponsestodisaster.Avarietyofassessmentswereused1)tobroadenthespectrumofinformationacquired,2)toincreasethedepthofinformation,3)toverifyvariablespreviouslydescribedintheliterature,and4)todiscoverunsuspectedvariables.Victimswereassessedsoonerthanisusualafteradisasterto learn aboutearlyreactionsandsymptoms.Burke,Borus,Burns,andMillstein andBurke,Moccia,BorusandBurns(1986)studiedchildren5and10monthsafterawinterstorm;GIeser,Green,andWinget(1981)andGreen&GIeser(1983)studiedtheBuffaloCreekfloodvictimstwoyearsafterthedisasteranddatacollectioniscontinuingtoday.Sixto18monthsisthetypicallengthoftimeforresearchtobeginfollowingadisaster.Aneffortwasmadetocompensateforthelackofpre-testdata.Finally,thepossibilityofdevelopingadiagnosticmeasurementofstresswasconsideredalongwiththefeasibility

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3of usin9 thesamplesinalaterlongitudinalstudy.Thattheearthquakestudycouldbegintwodaysfollowingthecompletionofthehurricanestudy,usingthesamemethodologyandtimeframe,wasremarkablyfortuitous,andprovidedacomparisonbetweendisasters.THEDISASTERSHurricaneHugostruckCharleston,SouthCarolina,onSeptember22,1989,sendinga14.98footstormsurgetothenorththatinundatedthevillageofMcClellanville.ThisCategory4(borderline5)stormhadwindsof135mphandgustsexceeding150mph.Theresidentshadsufficientwarningtoevacuateortoseekrefugeinthedesignatedshelter,alocalhighschool,butthewaterlevelwastypicallyfiveandahalffeetinmanydwellingsaswellasinthehighschoolcafeteria,causingmosttofearfortheirlife.Eventhosewhoevacuatedfrequentlyremainedinthepathofthestormtoendurehoursoffallingtreesandbrokenwindows.Anumberofhomesinthevillagewerelost,andmostoftheremaindersustainedextensivedamage.Mostpersonalpropertyincludingfood,clothes,furniture,appliances,andcarswaslost.Manyvictimshadexperiencedpriorhurricanesoflesserintensity,andeventhoughtheyhadwarningofHugo,theyhadnotexpectedeithertheintensityofwindnortheunprecedentedheightofthestormsurge.Ofthe35hurricane-relateddeaths(TheNews&Courier/TheEveningPost,1989),noneoccurredinMcClellanville.The Lorna PrietaEarthquakestruckonOctober17,1989,caus-

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4ingextensivedamagebetweenwatsonvilleandSanFrancisco,Cali-fornia.Themagnitude7.1quakestruckanareaknowntohavea30%probabilityofamoderateearthquakewithin30years.Therehadbeenseveralsmallerearthquakesinthemonthspriortothemainshock,butthepopulationdidnotregardthetemblorsasprecursorsandwereunpreparedforthemainshock.Therewere68deaths,thoughnoneoccurredintheSantaCruzMountainswheremostofthedataweregathered.Bothofthesedisasters,thoughmoderate,hadsufficientimpacttoexpectsomemeasurablepsychologicalresponse.TheAmericanRedCrossassessedMcClellanvilleasthemostseverelyaffectedareaoftheSoutheast.SAMPLESELECTIONElevenMcClellanvillefamilieswereinterviewed.Oftheseeleven,sixwereAfrican-Americanandfivewerecaucasian.Thesocio-economiclevelsrangedfromlowtomoderate.Eachfamilyhadatleastonechildbetweentheagesof6-16years.Each(withoneexception)wasatwo-parentfamily,oneofwhomwasinterviewed.ManyoftheCaucasianfamilieshadsenttheirchil-drenawayduringthecleanupwhichlimitedthesampletothosefamilieswithchildrenstillathome.TheAfrican-Americanfami-liessufferedthelossofhomesandcarstoagreaterextentthantheCaucasians.Therewere12earthquakefamiliesofwhomthreewereHis-panic.LornaPrietafamilysize,withtheexceptionoftheHis-panicfamilies,tendedtobesmallerthaninMcClellanville,with

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5moreonlychildren,andwiththreesingle-parentfamiliesandonestepparent.Manyofthefamiliesinbothareas'hadsimilarlev-elsofexpendableincome.Itwastheauthors'impressionthatearlyarrivalonthedis-asterscenecontributedtothehighlevelofcooperationreceivedfromthevictims.Thelatter,withoneexception,hadnotyetreachedthestageofneedingtoputthedisasterbehindthem,oroutofmindentirely.Itwasalsotruethatparentsseemedcon-cernedaboutthewelfareoftheirchildrenandwerewillingtodoanythingthatmightbenefitboththeirchildrenandothers.Onlyonefamilyfromeachsamplerefusedtoparticipate,andonefam-ilyfailedtoappearfortheinterviewinMcClellanville.Ashasbeennotedbyothers(YuleandWilliams,1990;McFarlane,1987)teacherswereagoodsourceofinformationearlyinthestudy,butitwasdifficulttoobtaintheircooperationlater.Byrestrictingthesamplestospecificgeographicalareaswithineachdisasterregion,thehomogeneityofthesamplewasencouraged,andtheimpactofthedisasterscouldbeexpectedtobesimilarforthevictims,therebylimitingvariationintheimpactvariable.Infact,duetothechoiceofwhetherornottoevacuatefromthehurricane,orthattheearthquakeoccurredwhenpeoplemighthavebeenathorne,atwork,orontheroad,indoorsorout,somevariabilityoccurredintheactualexperienceofeachdisaster.Thesustaineddamage,however,wasmoreuniform.Interviewswereconductedbetweenoneandfourweeksofthedisasters.Thiscannotbeconsideredarandomsampleintheusualsense

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6ofthetermbecauseeveryfamilywasinterviewedforwhichtherewasbothtimeandaccess.Families were recruitedfromtheshelter,walkingtheneighborhood,orreferrals.Familieswererejectedonlyiftheirchildrenwereunavailableorofaninappropriateage.Aresearchteamlargerthantwowouldhaveenabledtheuseofrandomizationtechniques,andwouldalsohavefacilitatedlargersamplesizes,especiallynecessaryfor"crossculturalcomparisons.Self-reportdatawasalsocollectedfromfifthandsixthgradechildrenintheirschoolclasses.PROCEDUREParentemotionalstatewasconsideredanimportantfactorbearingonthechild'semotionalstateinseveralpreviousstudies(Bloch,Silber,andPerry,1956;Olsen,1973;Handfordetal.,1986).ParentalemotionalstatewasassessedusingtheSCL-90-R(Derogatis,1977),a90question,2-pageformyielding9symptomgroups.TheparentwasthenaskedtofilloutaChildBehaviorChecklist(Auchenbach&Edlebrock,1988)oneachappropriately-agedchild(6-16years)toprovideameasureofthechild'semotionalstatus.Becauseitisusuallyimpossibletogatherpre-disasterdata,eachrespondentwasaskedtocompletethesecheckliststwice,onceasshefeltbeforethedisasterandagainasshefeltafterward.Whilethisishardlyanerror-freeapproach,asitreliesonmemoryofanearlierstate,itproducedsomeinterestingresults.Therespondentsseemedabletomakethedistinction

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7betweenpre-andpost-disasterstates,particularlyintermsofthechangeinfeelingsorparticularsymptoms,ifnotinrememberingtheactualbaselinevalueofasymptom.Theyknewwhichsymptomsincreasedordecreasedandfeltabletoquantifythechanges.ThisapproachhasbeenusedbyHandfordetale.(1986)andOllendickandHoffmann(1982).TheparentwasthengivenastructuredinterviewbasedontheDIS/DisasterSupplement(1983).ItincludedsomequestionsonresiliencyfactorsbasedonWerner's work.Italsocontainedapost-traumaticstresslistbasedontheDIS/DS,Horowitz'sImpactofEventsScale(Horowitz,Wilner,andAlvarez,1979)andavarietyofothersymptomsgleanedfromtheliteratureandclinicians.Theparentwasalsoaskedtodescribetheexperienceofthedisaster,reactionstoit,andfeelingsaboutit,forbothherselfandthefamilymembersinanopen-ended,nondirectedway.Thisapproachobtainedinformationastructuredinterviewmightmiss.Thisaccountwasrecordedverbatim.Lastly,theywereaskedaboutpositiveoutcomesfromthedisaster.Thefamilymemberswereinterviewedseparatelytoavoidthey'reinfluencingeachother'sresponses.Becausesomeresearchers(Garrison&Earls,1985;ReichandEarls,1987;Pynoosetal.,1987)areproponentsofutilizingchildrenasinformationsources,thechildrenwereaskedtocompletetheYouthSelfReportform(Auchenbach&Edlebrock,1988),bothastheyfeltbeforeandafterthedisaster(ifnineortenyearsorolder).Theywereaskedtodrawapictureoftheirfamily.They

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8werethengivenastructuredinterviewsimilarto,butshorterthan,theparentversion.Italsoincludedapost-traumaticstresschecklistwordedmoresimplyforchildrenandincludingafewadditionalquestionsaboutschoolandsleeppatterns.Theywereaskedtodescribethedisasterandtheir toitinanunstructuredway,astheydrewapictureofthedisaster.Finally,theywereaskedaboutgoodoutcomesfromthedisaster.Thisisatime-consumingbatterytocomplete,andyettheparentsneithercomplainedabqutthetime,norappearedtorushthroughitthoughtlessly.Rather,theyseemedtousetheopportunitytosharefeelingsandreactions,perhapsforthefirsttimesincethedisaster.Itappearedtohavetherapeuticvalue,andtherespondentsweresUfficientlyenthusiastictoofferreferrals,andtovolunteerforalaterstudy.ThedatawereanalyzedusingtheStatisticalPackagefor.SocialSciences(SPSS)andMystatcomputersoftware.RESULTSThetwosamplestotaled23familieswith48children:Hurricane:11familieshad27children;Earthquake:12familieshad21children.Nearlytwothirdsofthefamiliesenduredsubstantialdisasterimpact,thatis,theywereinafloodedhomeorshelterortheylosttheirhome.Mostofthesewerehurricanevictims.

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9ParentEmotionalstatus:TheparentsmeanoverallscoresontheSCL-90-R(Derogatis,1977),ameasureofemotionalstatus,were:Before.4%tile70After1.03%tile93AsubstantialsymptomlevelisdefinedbyDerogatisasthe89thpercentile.Thereweresubstantialincreases(betweenpre-andpost-disasterscores)ineverysymptomcategoryexcept"Psychotic."Thiswasshownusingpairedttests(p=.000to.028).Whencomparedtothenormsforthischecklist,theparentsappearedtooverestimatetheir"before"scoresinallbutthreesymptomcate-gories.Thissuggeststhattheparents'memorywascoloredbytheinterveningdisasterandlimitstheusefulnessof"before"datagatheredbyaskingthevictimstorememberandestimateapre-disasteremotionalstate.Thenumericalvaluesofthepre-disasterscoresshouldnotbeacceptedasaccurate,butthescoredifferencesmaysuggestsymptomcategoriesand,toalesserextent,possiblemagnitudeofeffects.Handfordetal.(1986),intheirstudyofparentreactiontotheThreeMileIslandaccident,usedtheSCL-90-Rinasimilarpre-andpost-disastermethodofdatacollection,andtheyalsofoundelevatedpost-disasterscores(attwotofourmonthsafterthedisaster).Theydidnot,however,comparethepre-disaster

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10datatothenorms,andthus,lackedabasiswithwhichtojudgethenumericalvalueofthepre-disasterscores,northemagnitudeofthepre-andpost-disasterchanges.Theoverallsummaryscore(GSI),despitehighervaluesforearthquakevictims,didnothavet-testvaluessufficientlylargetoconcludeotherthanthattherewerenosignificantdifferencesbetweenhurricaneandearthquakeadultvictims(t(22)=1.87,P=.07).Thismayimplythatthetwodisastershadasimilarimpactontheiradultvictims,despitethefactthatsixhurricanefamilieslosttheirhomeswhileonlyoneearthquakefamilylosttheirs.Thesimilarityinscoresmayhavebeen'facilitatedbytheneedtorepairhousesafterbothdisasters,despitetheeffectsofaftershocksandlackofwarningthataddedtothestress ofearthquakevictims.Children'sEmotionalstatus:CHILD BEHAVIOR CHECKLIST.Theparent-completedChildBehaviorChecklist(CBC)(Auchenbach&Edelbrock,1988,1983)showedscoresintheabnormalrange(abovethe98thpercentileasdefinedbyAchenbachandEdelbrock(1983)for17ofthe23families,including40.5%ofthechildren,primarilyintheSomaticandSchizoidsymptomcategories.TheCBCauthorswarnthattheSchizoidcategoryisnottobetakenasadiagnosisofschizoidsymptoms.Infact,theresponsesinthiscategorystatedanxietyabouthurricanes,aftershocks,daydreamingorfearsofanimals.ManyoftheSouthCarolinachildrenmentionedafearofsnakes,alligators,and

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11dogs.AfewCaliforniachildrenalsomentionedafearofdogs.Itmightbewelltoviewthiscategoryasrepresentingworryoranxietyratherthanthoughtdisorder.ThedifferencesinSomaticComplaintscoresbetweenhurricanevictims(n=26)and.earthquakevictims(n=16)weresignificant(t=-2.27,P=.028).Thissuggeststhatthelattersufferedmoredistressthandidthechildreninthehurricane.Thismayhavebeenduetothelackofwarningoftheearthquake,shakingof.the.initialshock,theaftershocks,orthefearofanothertemblor.Theyoungerchildrenregisteredmoreproblemsthantheolderchildren,particularlytheyoungerboys.Theolderboysseemedtoexhibitadevelopmentalshifttowardcopingbehaviorthattheyoungerboyswereunabletomanage.Thelattermayhavebeenthreatenednotonlybythecrisis,butbychangesinparentalbehaviorthatcouldbedealtwithprimarilyby"actingout"behaviorally.They mayhavebeenlessabletoabsorbcognitivelyallthathadhappened,and to userationalthinkingtocopewiththeirfears.Moreover,familydynamicsseemtobemoreimportantforyoungerchildren.Theadolescentswereobservedtobelessinvolvedwithfamilyandmoreinterestedinpeers,school,andintheirownlivesandtheirfuture.AswastrueoftheSCL-90-R,the"before"scoreswerehigherthanthenormsforthesechildren,thoughsignificantlysoinonlytwocategories.Becausethe"before"scoreswereclosertothenormsforthechildrenthanfortheparents,thissuggeststhatthetendencytooverrateone'schildrenmaybeoccurringtoalesserextentthanwithoneself,andthattheparentsmaybeviewingtheirchil-

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12dren'spre-disasterbehavior reasonably realistically.Thislendssupporttothismethodofcollectingpre-disasterdata,particularlytheuseofnumericalvaluesforchildrenasratedbyparents.Parentpsychopathologyisofinterestinthisstudy.ItwasamongWerner's(1989)riskfactorsthatledtoloweredresil-iency.Atleastonestudy(Blochetal.,1956)mentionedtheemotionalhealthoftheparentspriortoadisasterasaffectingthechild'sresponsetothedisaster.Whenparents'pre-disasterscores(GSIbef)werecorrelatedwiththechildren'sCBCscores,theresultswereasfollows:Table1Children'sCBCscorescorrelatedwithparentpre-disasterpathology GS1bef:r=p=SchizSomatAggres.44.002Deling.32.019Hyper.27.044

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13ThehigherGSIbefscore(prior-problem)parentsweremorelikelytonoteaggressive,delinquent,orhyperactivebehaviors.Thesebehaviorswereamongthemoreovertandintrusiveoftheproblems.Thelower-scoringparentstendedtoseesomatic,anxious,depressive,andobsessive-compulsivesymptoms.Whiletheremayhavebeendifferencesinperception,itmayalsobetruethat"actingout"behaviorsaremoredifficultforhighlystressedparentstodealwith,andthereforeratedmorenegatively.TherewasnosignificantcorrelationbetweentheGSIbefandthechil"dren'sYouthSelfReport(YSR)scores.YOUTHSELFREPORTCHECKLIST.Thechild-completedYouthSelf-Reportform(YSR)(Auchenback&Edelbrock,1988,1987)revealed27of30childrenwhofelttheyhadsomeproblems,and9ofthose27 whoplacedabovethe98thpercentile.TheyplacedthemselvesintheSomatic(n=2)andThoughtDisordercategories(n=8.)(ThoughtDisorder,likeSchizoidintheCBC,reflectedworries,especiallyaboutthedisaster,andnotpsychosis.)Twoofthechildrennotedproblemsinthemselvesnotnoticedbytheirparents,whereasfiveoftheparentsnotedproblemsintheirchildrenthatwerenotmentionedbythechildrenthemselves.withasingleexception,theparentsdidnotcheckthoughtdisorderitems;theywerebetteratseeingovertbehaviorproblems,andtheywerebetteratitthantheirchildren.ThisfindingiscorroboratedbyWeissman,Orvaschel,andPadian,(1980)intheircomparisonofchecklistsandself-

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14reportscales.Theseresultsalsosuggestthatworriedchildrenknewtheywereworriedandcouldreportit,buttheydidnotseethatitaffectedtheirbehavior.Whencomparingthe"before"andafterscores,theincreaseswerenotsignificantsaveforthegirls'Somaticscores(t=2.776,P=.017.)Thissuggeststhatcollecting"before"datainthiswaywaslessmeaningfulfromthechildrenthanfromtheadults.Thechildrenhavelessofasenseofselfthantheparents,andmaynotbeasreliableas a sourceofinformationabouttheiremotionalstateeitherbeforeorfollowingadisaster.Oneinterestingcontradictionisthattheolderboysviewedtheirbehaviorasworsening(albeitbelowthelevelofsignificance),whereastheirparentssawimprovement.Theseboysmayhavebeenfeelingthreatenedandanxiousduetotherecentdisaster,andbecamemoreconsciousoftheirbehaviorresultinginguiltyfeelingsaboutmisbehavior.Thus,theymayhaveperceivedtheirbehaviorasworsethanitreallywas,andtriedtocompensateforit,givingtheirparentsafavorableimpression.AnotherdiscrepancybetweentheparentandchildviewsappearsintheoldergirlsAggressionscore.Itworsensintheparents'opinion,andimprovesinthegirls'view.Again,thebehaviorverywellmayhaveworsened,butthechildmayhaveneededtoseeimprovementwhentoseerealitymayhavebeentoothreatening.Ingeneral,theYSRdoesnotappeartobethebestsourceofinformationunderthesecircumstances.

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15POST-TRAUMATIC STRESS-PARENT.ThePost-TraumaticStresslist(PTS-P)giventotheparentwascorrelatedwiththeparentpathology(GSIafter)afterthedisasterrevealing,notunexpectedly,asignificantrelationship(r=.56,P=.004.)WhenPTS-Parentscoreswerecomparedforhurricaneandearthquakevictims,therewasnosignificantdifference.Apparently,adultvictimsfrombothdisasterswereexperiencingsimilarlevelsofstressbasedonthismeasure.Therewasasignificantnegativecorrelationbetweentheparentpost-disasterpathologyandtheChildren'sYSRSomaticcategory(r=-.32,P=.05).TherewasalsoanegativecorrelationbetweenparentpathologyandThoughtDisordercategory(r=-.34,P=.04).Thissuggeststhatastheparentemotionalstateworsened,thechildrenneededtocompensateintheoppositedirection,perhapstoholdthefamilytogether.Similarnegativecorrelationssupportingthisviewappearbelow.POST-TRAUMATIC STRESS-CHILD.Unliketheadultresults,thedifferencesbetweenPTS-Childmeanscoresforhurricaneandearthquakechildvictimsweresignificant(t(45)=-2.83,P=.007).Thisdifferencebetweenthemeanssuggeststhattheearthquakechildrenexperiencedmorestressthandidthehurricanechildren.Asmentionedabove,theremayhavebeendifferencesbetweendisasters(earthquakesmightbemorefrightening),thelackofwarningpriorofanearthquakemayhaveexacerbatedthestress,andtheaftershocks

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16mayhavepreventrapidrecovery.ItisalsopossiblethatCali-forniachildrenweremoreself-revealingthanSouthCarolinachildren,orthattheethnicdifferencesbetweentheinterviewersandsomeofthehurricanechildrenbiasedtheresults.Thedifferenceinstresslevelsofparentsandchildrensug-geststhattheparentsmayhavebeenfocusedonthedamageandrepairs,whereasthechildren,lackingadistractionsuchashouserepair,werefocusingonthedisasteritself.WhilethePTS-Childscoresareevenlydistributedovertherangeofpossiblescores,theevidenceofevenonesymptommightbeanindicationofdisturbance,especiallyifthesymptomwasnotevidentbeforethedisaster.Achildwhodevotesconsider-ableenergytodenyingdistressbothtohimselfandtootherscanbeexpectedtoacknowledgefewsymptoms.Infact,achildwithzerosymptomsinasampleofchildrenwith'substantialdisasterimpactandmUltiplesymptomsshouldalertanobservertopossibledenial.PTS-ParentscoreswerecorrelatedwithPTS-Childscores(r=-.39,P=.005).Inbothdisastersparentswithhighstressscoreshadchildrenwithlowstressscores,withtheinversealsotrue.A4x4matrixillustratesthe16possibilities.Nineofthepossibilitiesarerealisticinthisstudy.

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17ChildrenLowstressScoresHighStressScorestruelowstresstruehighstressdeniedtruehighstresstruelowstressdeniedParentLowtruelowpossi-#stressbleStresstruehighpossi-#ScoresstressdeniedbleHightruehigh**#stressStresstruelow............... ............... .............................................stressdenied...............Scores............... .............................. ............ ...............* *possible.. ............... ............... ............... ............... ............................................... .............................. .............................. ............................................. ............... ............... ............... ............... ............... ............................................................ ............... ............... .............................. ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... .. .. .. .. .... .. ....*-reflectcalculatedcorrelation.#-groupsofinterestindeterminingtruecondition....unrealisticpossibilities.1.Itisreasonabletoexpectlowstressscorevictimstobeeithertrulylowstress,ortobe,infact,highlystressedbutattempingtoconcealordenytheirtruestate.2.Itisreasonabletoexpecthighstressscorevictimstoexhibitsignsofhighstress.Itisnotreasonabletoexpecthighstressscorevictimstobe,inreality,trulylowstressinterestedinfakinghighstressscoresexceptforpotentialgainsuchastimeoffforwork,disabilityorinsurancepayments,etc.Thenatureofthisstudywouldnotprovidetheseincentives.

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18Theastericksassumethattheparent'sstressdeterminesthatofthechild,thoughthereversemightbetruetoalesserdegree.Achildinahighlystressedstatecouldlowertheparent'sthresholdforshowingstresssymptoms.Itistheauthors'impression,however,thatthechildrenwatchedandwaitedforparentalexamplesofbehaviors,expectations,andfeelings,andthendrewconclusionsabouthowtothink,feelandreact.Theparametersofthisprocessinchildrenraisepotentiallyinterestingresearchquestions.ForthechildrenitistheTrueHighstressDeniedgroup(#)thatisofgreatestinterest,becausetheyarethegroupmostlikelytoescapedetectionandattentiongiventheirlowstressscoresandfewerstresssymptoms.Thenegativecorrelationbetweenparentandchildstressscoresmayindicatethatchildrenofhigh-stressparentsfeeltheyneedtostaycalmtoholdthefamilytogetherortokeepitrunning,andinsodoingmustassumealowstressrole.Itshouldalsoraisethequestionofwhethertheirconditionistrulylowstressoroneof'truehighstressdenied,'andshouldfurtherscreening,therapy,orotherinterventionbeutilized?Istheirreactiontobeconsideredasuccessfulcopingstyle,oranindicatoroffutureproblems?Thisnegativecorrelationsuggestsinterestingpossibilities.Itmaybefeasible,witharefinementofthesechecklists,todevelopareasonablepredictorofchilddisasterstress.Iflowstressparentshavehigh-stresschildren,andifitisfairly

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19easytoelicitgoodresponsesandcooperationfrom p-arent,asitseemstobe,andifitisfairlydifficulttoelicitresponsesfromchildrenasappearstobethecase,thenashort,15to.2o-itemchecklistansweredbyacooperativeparentabouthimselfmaybeafairpredictorforhischildren.Itistheourimpressionthatthelowscoringparentswerealsoamongthemostcontrolled.Theywereoutwardlyorganized,careful,calm,andundemonstrative,buttheyseemedtohaveanunderlyingleveloftensionthattheirchildrenmaypickupandactout.Smith(1983),inreferringtothevictimsoftheSanFernandoearthquake,statedthesituationconcisely:"Parentalfearsthatareunrecognizedordeniedheightenachild'sfears..."Thetensionwasmostapparentwhenthesein-controlparentswerecontrastedwiththosevictimswhoputeverythingintheirGod'shands,therebyallowingthemselvestorelax,toacceptwhathadhappenedandwhatwastocome.Inthelattervictims,theirwordswerecongruentwithboththeirbearingandtheirunconsciousactions.Thetenseparents,incontrast,werenotcongruent.Theymightsaytheyhadeverythingundercontrol,butthetoneofvoice,themannerofspeaking,thewaysinwhichtheyheldtheirstiffbodyordartedtheireyes,alloftheseuncontrolledsignsbetrayedtheirunderlyingtension.Variablesthathavebeensignificantinotherstudiesdidnot,foravarietyofreasons,appeartobesointhisone.Forexample,thevariablesSeparationfromParent,PriorEmotionalProblems,PriorDisasters,Sexofvictim,andImpactofDisasterwerenotsignificantinthesedisasters.BirthOrder,onthe

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20otherhand,mayhavebeenimportant.The qldeat childineachof13familieshadthelowestPTS-Childscoreofthesiblings.Theiragesrangedfrom9to16years.Themiddlechildofonlyfourfamilieshadscoreslowerthanhisoldersiblings.Theiragesrangedfrom9to14years.Thus,whiletheagesofbothgroupsspanthesamerange,thefirst-born,regardlessofage,hadlowerstressscoresthanlaterbornchildren.Thissuggeststhatbirthordermaybemoreimportantthanage.Itmayalsosuggestthattheroleof"distressedvictim"isnotperceivedasanoptiontothefirstborn,butitisavailabletotheyoungerchildrenaswasfoundbyBlochetal.(1956).Post-Traumaticstressscoresofthechildren(PTS-C)werecorrelatedwiththeYouthSelfReport(YSR)scoresinthesixgroupscommontobothsexes:Table2CorrelationofPTS-CwithYSRafproblemgroupsYSRafDepres.Unpop.Somat.Th.Dis.Del.AggrPTS-C:r=.56.41.38.59.40.36P=.001.016.026.001 .019.033

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21Thissuggeststhatthechildrenareconsistentinrecordingtheirstressandtheirotherproblems;theirstressisreflectedinbothmeasures.TheYSR,however,wasnotabletodiscriminatebetweenearthquakeandhurricanechildrenaswasthePTS-Child.Interestingly,manyofthehighestcorrelationsofthePTS-ChildwerewithYSRgroupsthatrarelyfiguresignificantlyinanyoftheotheranalyses.Depression,forexample,wasacauseofconcernbecauseitwasexpected,andyet,withoneexception(CBC,youngerboys),itneverregisteredatsignificantlevels.RESILIENCY VARIABLES.Theresearchhypothesesstatedthatthosechildrenhighinresiliencyfactorswerelesslikelytodevelopemotionalreac-tionsorovertpathologyorsufferstress;andthosechildrenlowinresiliencyfactorsweremorelikelytodevelopnegativeemo-tionalreactions,pathologyandstresssymptoms.Theresultstendedsupportthesehypotheses(seeTable3).Tosimplfytheanalysis,manyoftheinterviewquestionsdealingwithresiliencyfactorsweregroupedintovariables,fourofwhicharedescribedbelow:1.FamilyInstability--thesumofnineitemsincludingmaritalstatus,unemployment,troublewithsomeaspectofthesociety,answeredbytheparent;2.FamilyDiscord--themeanof11itemsreflectinghowwellparentsgetalongwiththeirchildrenandeachother,answeredbytheparent;3.ChildInstability--thesumof16itemsdealingwithfriends,familydiscord,substanceabuse,andproblem-solving,

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22answeredbythechild;4.Child'sTemperament--thesumof10itemsrevealingeating,sleeping,orirritabilityproblemsduringthe1styearoflife,answeredbytheparent.TheresiliencyvariableswerecorrelatedwiththeParent'sGSIandPTS-Pscores,andwiththechildren'sPTS-C,CBCandtheYSRscores.TheresultsareshowninTable3.Table3Correlationofprotocolsandresiliencyvariables

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1 FamilyInstabCPl2 3Discord(PlInstab.(Cl234Temperam.YSRaf:Unpop:r=.44P=.015Somatic:r=-.40P=.021Delinq:r=.42P=.016Aggress:-r=.33P=.058Onlysignificantdatawerepresentedinthistable,withtheexceptionofthePTS-Childcorrelation.Thenegativecorrelationofthechild'sPost-TraumaticStress(PTS-C)scorewiththechild'sviewoffamilyinstabilitysup-portsthenegativePTScorrelationsmentionedabove,andthetheorythatlow-stressscoreparentstendtohavehigh-stressscorechildrenwhoperceivetheunderlyingtensioninthefamilyandreflectitintheFamilyInstabilityvariable.TheYSRSomaticscoresarealsonegativelycorrelatedwithparent'sviewoffamilyinstability,andthenegativecorrelationbetweentheparent'sPost-TraumaticStress(PTS-P)scoreandthechild'sviewoffamilyinstabilityalsoseemtosupportthetheory.Increasesintheparent'spathologyscore(GSI)leadtoincreasesinthe

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24FamilyInstabilityvariable,suggestingthatstressfulfamilycircumstancesleavetheparentlessableto,copewiththedisasterstress.ThehighcorrelationbetweentheFamilyDiscordvariableandtheparent'spost-disasterpathologyscoresuggeststhattheentirefamilyisorhasbeenunderstresswhichworsensastheparent'sconditionworsens.This'studygeneratedaconsiderableamountofadditionaldatathatawaitsfurtheranalysisandfollow-up.DISCUSSIONTherewerefivemainfindingsarisingfromthisstudy:1)Theresearchhypotheses,thatchildrenhighinresiliencyfactorswouldwithstanddisasterstressbetterthanthoselowinresiliencefactors,tendedtobeverified.Afactoranalysis(tobedone)willrevealwhichfactorsaremostinfluential.Birthorder,effectsofthedisaster,andpriorproblemsshowsomepotentialforfurtherexploration.Othervariablestested-sex,previousdisasters,andseparation--werenotsignificantinthesedisasters.Theseparationvariablenotwithstanding,familydynamicsappeartoplayamajorroleinthechild'sreactionandadjustmenttomajorcalamitiesassuggestedbybirthorder,priorproblems,andtheEffectsvariable(thatincludedseveralfactorsdealingwithseparationfromparentsandsiblings).Separationusuallydidnotoccurtothehurricanevictimsduetoforewarning,andmayhaveplayedaroleintheearthquakeaftermaththatwasbeyondsimplemeasurement.Astheimpactofdisasterisfurtherexplored,afocusonfamilydynamicsshould

PAGE 27

25receivehighpriority.2)Theinversecorrelationbetweenparentstressscoresandchildstressscoresisinterestingandworthyoffurtherexploration.Afactoranalysisofthepost-traumaticstresssymptomsmightberevealing,especiallyasrelatedtoparentpathology,familydynamics,andresilienceandothervariables.Theexplanationofthisnegativecorrelationmaybethatsome children tendtominimizeordenytheirowndistress,particularlyinthepresenceofadverseparentalreaction.ThissupportstheroletheoryofBlochetale(1956)andSilber,Perry,andBloch(1958),thatstatesthatonlyonememberofafamilyatatimemaytakeontheroleofimpairedvictim.Thechildmustcompensateoratleastnotbecomeanymoredysfunctionalastheparentemotionalstateworsens.Thisisanindicationoftheimportanceoffamilydynamicstochildresponse(inthefaceofanextremestressor).Severalothermeasuressupportthisdynamic:a)thenegativecorrelationbetweenPTS-ChildandtheInstabilityvariable(child'sviewoffamilyinstability);b)thestrongpositivecorrelationbetweenthissameInstabilityvariableandthePTS-Parent;c)thenegativecorrelationsbetweentheGSI(parentpathology)andtheYSR(child)SomaticandThoughtDisordergroups;d)andpossiblythedeclineintheCBCscoresfortheolderboys(noneofwhich,however,reachedthep=.05levelofsignificance).Thisdynamic(aspathologyincreases,childresilienceseemstoincreasewithdecreasingstress)tendstoconfoundtherela-

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26tionshipbetweenresilienceandpathology(aspathologyincreases,resilienceshoulddecrease),andamorecomplexmodelisneeded.3)TheabilityofthePTS-Childmeasuretoseparatehurricanefromearthquakevictimswhenmostothermeasureswereinsensitivetothedifferencesuggestssomepromiseforthisinstrument.Theonlyotheraccesstothechild'semotionalstatewastheinformationontheEffectsvariablegatheredfromtheChildInterviewandtheartwork.Whenaskeddirectlyaboutsymptomsandeffects,thechildrenappearedtorespondreadilyandinawaythatmadeearthquakevictimsquantifiablydistinguishablefromhurricanevictims.TheresultsofthePTS-Childmeasurealsosuggestthatthechildrenmaybemorefocusedonthedisasterexperiencethanontherepairsforwhichtheyhavelittleornoresponsibility,andwhichtheyseeastheirparents'concern.Itisalsopossiblethatearthquakesmaybemorefrighteningthanhurricanes;perhapsthelackofwarningismoreunnerving;perhapsthe'continualaftershocksraisetheindividualand/ortheambientstresslevelThereisalwaysthepossibilityofculturaldifferencesaccountingfordifferencesinresponses.Unfortunately,thesampleofeachethnicgroupforeachdisasterwastoo small todeterminetheeffectofculturaldifferences.Theremayalsoberegionaldifferences.ItisconceivablethatchildrenintheSoutheast,whencomparedwithwestcoastchildren,havedifferentperceptionsofhurricanes(basedonpriorexperiencewiththem)thantheperceptionsofearthquakes

PAGE 29

27heldbyCaliforniachildren.Moreover,SouthCarolinachildrenmaybeexpected ?y theirelderstorespondtoquestionsabouthurricanesorquestionsposedbyadultsinaparticularway.Clearly,theattitudeofrespectforadults,asseeninSouthCarolinachildrenandtheirmanners,isdifferentfromtheattitudeheldbyCaiiforniachildren;behindtheattitudemaylieadifferentbasisforresponsetoahurricaneortoachecklistpresentedbyanadult.Theremayalsobecustomarylimitsonthedegree of opennessandcandor,admissionoffearorproblemsthatvarybetweenregions.AstudyofanearthquakeinSouthCarolinamightremovethisregionalvariable.4)Theparentemotionalstateappearstohaveworseneddramatically,andwaseasilymeasuredusingtheSCL-90-RandPTS-P.TheinabilityoftheSCL-90-RandthePTS-Parenttodistinguishbetweenadulthurricaneandearthquakevictimsmayindicatesimilarlevelsofstress.Theparentsmaybefocusedonsimilardegreesofdamageandrepair,andnotonthedisasterexperienceitself.Eventheaftershocksthatmadeparentsuneasywerenotsufficienttogenerateadifferencebetweenthetwodisastergroups.TheImpactvariablealsosuggeststhattheirexperiencesweresimilar.Fromanotherpointofview,howisitpossiblethatthosehurricanevictimswhoenduredhoursstandinginthecoldandrisingwaterwiththeirchildrenontheirshoulders,convincedoftheimminenceofdeath,didnotregistersUbstantiallyhigherlevelsofstressthanearthquakevictimsforwhomthetemblorlastedonly15seconds?Weretheyinastateofdenialwhenin-

PAGE 30

28terviewedaweeklater?willtheybegintoexperienceflashbacks,?ightmares,'orothersymptomsofpost-traumaticstresssixmonthsorayearafterthedisaster?willtheybelessabletoworkormoredifficulttolivewith?ZivandIsraeli(1979)invokeSchachter's(1959)theoryofaffiliationtoexplainlowanxietyamongkibbutzimchildrenwhoexperiencedfrequentbombardment."Inhisinvestigationsoffear-andanxiety-producingsituations,Schachtershowedthatwhenanindividualremainswithinagroupduringafear-producingsituationhisanxietydecreases;thisexplainswhypeopleprefertobeinthecompanyofthoseexperiencingsimilarfrighteningexperiences."Halfofthehurricanevictimsweretogetherinthefloodedshelterandlatersharedasafeshelter.Mostoftheotherhalfweatheredthestormwithrelatives.Perhapsthisexplainstheirlowscoresinthefaceofapotentiallyfatalexperience.Thevalueofastudytofollowthesevictimsoveralongperiodoftime,andtheneedforbettermethodsofassessment,isevident.5)Theparentsseemedtobeabettersourceofinformationabouttheirchildrenthanthechildrenthemselvesfollowingadisasterofthemagnitudesofthishurricaneandearthquake.TheChildBehaviorChecklist(CBC)seemsbetterabletoelicitapictureofthechild'semotionalstatethandoestheYouthSelfReport(YSR),thoughthelistofstresssymptoms(PTS-Child)seemstohaveproducedgooddata.Theolderboysseemtohaveimproved,intheirparent'sview,thoughnoneoftheimprovementswerelargeenoughtobesignificant,andtheboyssawthemselvesasworsening.Theymayhopeto

PAGE 31

29behelpfulinademandingsituation;ortheymaybeafraidtorockthefamilyboatbyactingoutforfearoflosingevenmoreparentallovefromanalreadydistractedparent;ortheymaybefollowingculturalexpectationstotakeoverandsolveproblemsbymanipulatingtheexternalenvironment--helpingwithrepairs.Thegirlsshowdysfunctionalincreasesinmostbehaviorgroups,thoughthechangesaresignificantonlyinthesomaticgroup.Theypickingupandreflectingparentaldysfunction.Thegirls'somaticsymptomsincreasedsUbstantially,especiallyfortheearthquakevictims.somaticsymptomsmaybemoreacceptableforgirlstoexpress,andeasierforparentstonotice.ThelackofcorrelationbetweentheCBCandthePTS-Childsuggestsaparentalinabilitytodetectspecificdisasterstress.PerhapsthePTS-Childsymptomsarethesortthataparentwouldneedtoinquireaboutdirectly,andthatlevelofcommunicationisnottakingplacebetweenvictimsandtheirchildren.Inthiscountryitmaybeuncommonforthatlevelofcommunicationtooccurbetweenparents and childrenunderthebestofcircumstances.somaticsymptomsmaybemoreeasilydiscussedthanfears,especiallygiventhatitmaybeculturallyunacceptabletoadmittofear.Onlyninechildrenrevealedthrough.theYSRthattheyfelttheyhadproblems,suggestingthatthechildrenarenotnecessarilythebestsourceofinformation,atleastaboutthesebehaviorgroups.Denialmaybeoperatinginthechildren,ortheYSRmaybelessappropriatefordisasterusethananinstrumentsuchasthePTS-Child.TheYSRwasnotabletodiscriminatebetweenhur-

PAGE 32

30ricaneandearthquakevictimsasweretheCBCandPTS-Child,thoughthecorrelationswerehigherthanweretheCBCwiththePTS-Child.Animportantreactionwastheimpactbroughtonbythesightofthedamagewroughtbythedisaster.Itwasonethingtosurvivetheinitialonslaughtofthedisaster,andquiteadifferentexperiencetoviewthedamage,reviewitdayafterday,andsuffertheemotionalconsequencesofrepeatedexposuretodevastation.Parentsandtheirchildren,inboththehurricaneandtheearthquake,describedthissecondimpactrepeatedlyandinemotionalterms.Whetheritworsenedtheeffectsofthedisaster,orultimatelyenabledthevictimstocometotermswiththetrauma,orbothsuccessively,isunclear,butitisworthyoffurtherstudy.Themitigatinginfluenceofaidinvariousformssuchasfood,clothing,money,volunteerlabor,housing,andinsuranceseemstohavehadasubstantialeffectontheparents'moraleandbehavior. The children,inturn,mayhaveabsorbedparentalattitudesandeitherstoredtheminaninternal,relativelyunnoticeableway,ordisplayedtheminovertreaction.Thatsome,perhapsmany,oftheseformsofaidreachedthelowersocioeconomicclasseslater,ifat cannothelpregisteringonfamilies.Volunteerlabor,inboththehurricaneandtheearthquake,wasparticularlyimportanttothevictimsofthosedisasters,andwhenunavailable,moraledeclinedandwasreplacedbyanger,bitterness,despondency,andasenseofracially-motivatedinjustice.High-spiritedvolunteerlabor,whenpresent,appeared

PAGE 33

31toliftvictimsoutoftheirhelplessnessanddepression,andmotivatethemtohelpnotonlythemselves,butothersaswell.Theproblemswithgovernmentandprivatereliefagencieswerenotedandmayalsohavehadasignificantimpactonparentsand,consequently,ontheirchildren.Inevitably,asparentalmoraleebbedandflowed,thechildrenmayhavereflectedorabsorbedtheseattitudesandbehaviors.Anothersetofresearchquestionsneedingexplorationarosewhenthefollowingphenomenonwasobserved.Approximatelythreeorfourweeksafterthedisastertherebegantoemergeadesireamongsomevictimstoforgettheexperienceandallitssequelae.Isthiscommontomostvictims;doesitrepresentanecessaryphaseofrecovery;doesitfacilitaterecovery,andonlyundercertainconditionsorprecursors?Howshouldthisbedealtwiththerapeutically?Whatistheoperatingdynamicunderlyingthisphenomenon,whatdoesitrevealaboutcopingmechanismsandpersonalitystructure?Thesearequestionsneedingfurtherexploration.LimitationsInterventionbiasResearchinthefield,unlikelaboratoryconditions,issubjecttomanyunanticipated,uncontrolledanduncontrollablefactors,andthisstudywasnoexception.Forexample,itwasfoundthatthedisasterpopulationintheRedCrossShelterinGeorgetown,SouthCarolina,hadalreadybeenvisitedduringthefirstweekfollowingthedisasterbyseveralpeoplefunctioningasmen-

PAGE 34

32talhealthworkers.Theseincludedaschoolpsychologistwhodrewpictureswiththechildrenonthreeoccasions,ateacherwhousedsandtraysandawatertroughforgamesontwomornings,andacountymentalhealthworkerwhomadeatleastonevisit.Thesheltermanagerherselfhappenedtobeapsychiatricsocialworkercapableofdoingtherapyiftheneedarose.Therewerealsodailyvisitsbytheministerofthechurchinwhichtheshelterwashoused,aswellasbytheministersservingthetownofMcClellanville.Inthecourseofgatheringdatathefieldteam,too,undoubtedlyservedastherapeuticagentsinthatweencouragedpeopletotalkandaskedthechildrentodrawpictures.TheschoolsinbothSouthCarolinaandCaliforniahadalreadybeguntherapeuticactivitiessuchasgroupdiscussions,art,and orhadinformationallecturesonthecausesofthedisaster,allofwhichcouldbebeneficialtothechildrenleadingtosuccessfulcoping,adaptationandrecovery,andcausethemtomodifytheirresponsestotheassessment.EvenRedCrossandNationalGuardpersonnelweresupportiveandhelpful,andwerenotedbymanyvictimsasgreatlyappreciated.This,nodoubt,hadasubstantialtherapeuticeffect.Thesetwoagencieswerementionedfrequentlyassourcesofemotionalrelieffrom.stressthatwerethemosthelpfulofanysources.Theyprovidednecessitiessuchasfood,waterandshowers,theyweresourcesofupbeatcompanionship,andtheyalsofrequentlysurprisedvictimswithluxuriessuchasspecialfoods,parties,andevenabunnytoreplacealostpetforachild.

PAGE 35

33Ideally,noneoftheseinterventionswouldhaveoccurredbeforetheassessments,butsomeofthemclearlymadeahugedifferenceinthelivesofthevictims,anditissignificantthatthesocietywaswillingandabletorespondasitdid.ResponsebiasProblemsof-responsebias,whichoccurwhentherespondentanswersquestionsorchecklistsinaccurately,occurformanyreasonsandarenotlimitedtodisasterresearch.Onestudy(ReichandEarls,1987)noticedthatthechildrenwhoansweredallthequestionswith"no"didsooutofboredomandhadfoundawaytoendthetestquickly.Thatdidnotseemtobeasignificantprobleminthisstudy,withonlyoneknowndoubtfuloccurrence.Amorelikelyproblemwastheinabilityoftherespondenttoconcentrateonthetestsduetostress.When arespondentisstressed,onemustquestiontheaccuracyoftheresponses.Thoserespondentswhoweredeterminedtodenytheeffectsofthedisastermayhavetendedtounderreporttheirreactionscomparedwiththosewhowereveryawareoftheirfeelingsandreactions.Theproblemofdifferentiatingbetweenthosewhowereunderrespondingtothequestionsandthosewhowereminimallyaffectedwassometimesclarifiedintheinterviewnotes,butremainedunquantifiable. There' 'isalsotheproblemoftherespondentwhowishestoanswerin a'way thatpleasestheexaminer,orwhowishestoappearinagoodlight.Theserespondentsappearedtoanswertothebestoftheirabilities,andthismustbetakenasrepresen-

PAGE 36

34tativeoftheirperceptionsandstateatthetimeoftheinter-view.Itisimportant,andyetusuallyimpossible,toobtainpreandpost-disasterdata,hencetheattempttocollectbothkindsofdataatonetime.Whiletherespondentsseemedabletomakethedistinctionbetweentheirpre-andpost-disasterstates,relianceonmemoryissUbjecttoerror,andthereisnocheckonthiserrorotherthantheinferencestobemadebycomparisonwithnorms,alsosUbjecttoerror.Giventhatthepre-disasterstateswerehigherthanthenorms,thepost-disasterchangewasprobablygreaterthantheresultsindicate.

PAGE 37

35REFERENCESAchenbach, &Edelbrock,C.(1983).ManualfortheChildBehaviorChecklistandRevisedChildBehaviorProfile.Burlington,VT:UniversityofVermontDepartmentofPsychiatry.Achenbach, &Edelbrock,C.(1987).ManualfortheYouthSelf-ReportandProfile.Burlington,VT:UniversityofVermontDepartmentofPsychiatry.Achenbach,T.M.(1988)."ChildBehaviorChecklistforAges4-18",ed.11-88,BurlingtonVT.Achenbach,T.M.(1988)."YouthSelfReportforAges11-18",ed.11-88,BurlingtonVT.Bloch,D.A.,Silber,E.,&Perry,E. (195g). SomeFactorsintheEmotionalReactionofChildrentoDisaster.AmericanJournalofPsychiatry,113,416-422.Boore,J.A.(1990).TheRelationBetweenResiliencvandPsvchopathologyinChildrenWhoAreVictimsofNaturalDisaster.Unpublishedthesis,SchoolofEducation,SanJoseStateUniversity.Burke,J.D.Jr.,Borus,J.F.,Burns,B.J.,&Millstein,K. H.(1982).Changesinchildren'sbehaviorafteranaturaldisaster.AmericanJournalofPsychiatry,139(8),1010-1014.Burke,J.D.,Jr.,Moccia,P.,Borus,J.F.,&Burns,B.J.(1986).Emotionaldistressinfifth-gradechildrentenmonthsafteranaturaldisaster.JournaloftheAmericanAcademyofChildPsychiatry,25(4),536-541.Derogatis,L.R.(1977).SCL-90-R.Administration,scoring&Procedures.Manual-II.Towson,MD:ClinicalPsychometricRes.Garrison,W.T.,&Earls,F.(1985).Thechildbehaviorchecklistasascreeninginstrumentforyoungchildren.JournaloftheAmericanAcademyofChildPsychiatry,24(1),76-80.GIeser,G.C.,Green,B.L.,&Winget,C.,(1981).ProlongedPsychosocialEffectsofDisaster:AStudyofBuffaloCreek.N.Y.:Academic.

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36Green,B.L.,&GIeser,G.C.,(1983).stressand psycho pathol,ogy insurvivorsoftheBuffaloCreek disast.E=l:"-:.Origins ofPsychopathology:ProblemsinResearchandPublicPolicy,byRicks,D.F.,&Dohrenwend,B.S.,Handford,A.H.,Mayes,S.D.,Mattison,R.E, F.J.,II,Bagnato,S.,Bixler,E.0.,&Kales,J.D. (1986). ChildandparentreactiontotheThreeMileIslandnuclear.accident.JournaloftheAmericanAcademyofchildpsychiatry,25(3),346-356.Horowitz,M.,Wilner,N.,&Alvarez,W.(1979).Impactofeventscale:AMeasureofSUbjectiveStress.PsychosomaticMedicine,41(3),209-218.McFarlane,A.C.(1987).Familyfunctioningandoverprotectionfollowinganaturaldisaster:Thelongitudinal ofposttraumaticmorbidity.AustralianandNewZealandJournalofPsychiatry,21,pp.210-218.TheNewsandCourier/TheEveningPost.(1989)....AndHugoWasHisName:HurricaneHugo.ADiaryofDestruction.September21,1989.SunCitywest,Arizona:Boone.Ollendick,D.G.,Hoffmann,M.(1982).AssessmentofPSychologicalReactionsinDisastervictims.JournalofCommunityPsychology,10,157-167.Olson,R.A.(1973).IndividualandorgainzationdimensionsoftheSanFernandoearthquake.SanFernando,California,EarthquakeofFebruary9,1971,V.III,U.S.Dept.ofCommerce,NationalOceanic&AtmosphericAdministration.Pynoos,R.S.,Frederick,C.,Nader,K.,Arroyo,W.,Steinberg,A.,Eth,s.,Nunez,F.,Fairbanks,L.(1987).Lifethreatandposttraumaticstressinschool-agechildren.ArchivesofGeneralPsychiatry,44,pp.1057-1063Reich,W.,&Earls,F.(1987).RulesformakingpsychiatricdiagnosesinchildrenonthebasisofmUltiplesourcesofinformation:Preliminarystrategies.JournalofAbnormalChildPsychology,15(4),601-616.Schachter,S.(1959).Thepsychologyofaffiliation.Stanford,Calif.:Stanford.Silber,E.,Perry,S.E.,&Block,D. A.(1958).PatternsofParent-ChildInteractioninaDisaster.Psychiatry,21(2),59-167.Smith,S.(1983).Disaster:Familydisruptioninthewakeofnaturaldisaster.InFigley & McCubbin(Eds.),Stressandthefamily.II:Copingwithcatastrophe.Brunner/Mazel:N.Y.

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37 ty,st.Louis,Missouri.Diagnostic schedule;. -Oisaster Supplement.. ..'_'I__... Weissman,. .''Jand Children'sReports.TheJournalofNervousandMental Disease,168,12, pp.736-740.Werner,E. April).ChildrenoftheGardenIsland.ScientificAmerican,pp.106-111.Yule,W.& WIlLiams, R.M.(1990).Post-traumaticstressreactionsin childre"n:!::rJournal ofTraumaticStress, 1.(2), pp.279-295.ziv,Avner,&Israeli,Ruth,1973.Effectsofbombardmentonthemanifestanxietylevel.ofchildrenlivinginkibbutzim.Journalof Consulting} andClinicalPsychology,40(2),287-291.


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