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A study of the psychological effects of Hurricane Andrew on an elementary school population

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Title:
A study of the psychological effects of Hurricane Andrew on an elementary school population
Series Title:
Quick response research report ;
Physical Description:
22 p. : ill. ; 28 cm.
Language:
English
Creator:
Shaw, Jon A
Publisher:
Natural Hazards Research and Applications Center, University of Colorado
Place of Publication:
Boulder, Colo
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Subjects / Keywords:
Hurricane Andrew, 1992   ( lcsh )
Hurricanes -- Psychological aspects -- Florida -- Miami-Dade County   ( lcsh )
Child disaster victims -- Mental health   ( lcsh )
Post-traumatic stress disorder in children   ( lcsh )
Disasters -- Psychological aspects   ( lcsh )
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bibliography   ( marcgt )
non-fiction   ( marcgt )

Notes

Bibliography:
Includes bibliographical references (p. 11).
Additional Physical Form:
Also issued online as part of a joint project with the Louis de la Parte Florida Mental Health Institute (FMHI) Research Library’s disaster mental health initiative.
Statement of Responsibility:
by Jon A. Shaw ... et al..

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Resource Identifier:
aleph - 001985087
oclc - 33324754
usfldc doi - F57-00043
usfldc handle - f57.43
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A study of the psychological effects of Hurricane Andrew on an elementary school population /
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Natural Hazards Research and Applications Center, University of Colorado,
1993.
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[22] p. :
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Hurricane Andrew, 1992.
Hurricanes
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Natural Ha%ards Researchand-Applications Information Center Campus Box482UniversityofColorado Boulder, Colorado 80309..Q482\\OUStCO?'!AS'.rlJDY OP 'rIlEPSYCHOLOGXCALBPPECTS OP HURRXeutEDDRBWOlfANBLBHDJ'l'UY SCHOOL POPOLATXOlf ByJonA. ShawBrooksApplegateSusanTannerDorcusPerezEugeneRotheAna Campo-Bowen-BenjaminB.Lahey QUXCK RESPONSE RESEARCH REPORT#631993TheviewsexpressedinthisreportarethoseoftheauthorsandnotnecessarilythoseoftheNaturalHazardsCenterortheUniversityofColorado.InstituteofBehavioral Science 116 (303) 492.6818Telefax: (303)492-2151 BITNE'n HAZARDS@COLORADO Internet: haurds@vuf.Colorado.EDU

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NaturalHazards ResearchandApplicationsInformationCenterCampusBox482UniversityofColorado Boulder, Colorado 80309 ASTUDYOF THE PSYCHOLOGICALBFFECTSOF BtJRRICANBUDREW ON ANBLBKBNTARY SCHOOL POPULATION ByJonA. ShawBrooksApplegateSusanTannerDorcusPerezEugeneRotheAna Campo-BowenBenjaminB.Lahey QUICK RESPONSERESEARCHREPORT #63 1993This publication is partofthe Natural Hazards Research&Applications Information Center's ongoing Quick Response Research Report Series. http://WMN.colorado.edu/hazards TheviewsexpressedinthisreportarethoseoftheauthorsandnotnecessarilythoseoftheNaturalHazardsCenterortheUniversityofColorado.InstituteofBehavioral Science#6 (303) 492 Telefax: (303) 492-2151BITNET: HAZARDS@COLORADO Internet: hazards@vaxf.Colorado.EDU

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ASTUDYOF THE PSYCHOLOGICALEFFECTSOFHURRICANE ANDREW ON AN ELEMENTARY SCHOOL POPULATIONJonA.Shaw,M.D.,Brooks Applegate, Ph.D., Susan Tanner, Ph. D, Dorcus Perez,M.A.,Eugene Rothe,M.D.,Ana Campo-Bowen, M.D.&BenjaminB.Lahey, Ph.D. INTRODUCTION On24August1992,HurricaneAndrewdevastatedSouthMiamiwithwindsof164MPHdamagingapproximately100,000homes, apartments and trailers, leaving85,000unemployedwith35hurricane reported deaths. By October1992over10,000children,25%oftheschoolpopulationinthepathwayofthe hurricane hadtakenflightfromsouthDadeCounty.The psychologicaleffectsofdisastrous events on children has becomeanemergingfocusofstudyinrecentyears( Bloch et. ai,1956;Newman,1976;Terr,1981,1983;Burke et. aL,1986;Pynoos et. ai,1987;Green et. aL,1991;Kiser et.aL,1993).Terr(1991)hasnotedtheimportantroleofpsychictraumaasa crucial etiologicalfactorinthedevelopmentofanumberofseriouspsychiatricdisordersofchildhood and adulthood. Studiesofchildrenafternatural disaster haveconsistentlydemonstrated aspectrumofpost-traumaticsymptomstoincludetraumaspecific fears, fearsofrecurrence, anxiety, intrusive recollectionoftheimages andperceptsofthetraumaticevent, post-traumatic play, behavioral reenactments, regressive behavior,somaticills, avoidanceoftraumaticreminders, behavioral and school problems and changedattitudesabouttheself, world andthefuture.A numberofriskfactorshave been associatedwithvulnerabilitytoposttraumaticsymptomatologyLe.proximitytothezoneofimpact,personal injury, afamilymemberbeing injuredorkilled, parental response and psychopathology, degreeoflifethreat,familyambience, gender, preexistinganxietyand depression and early separations ( Bloch et. 1956;Milgram andMilgram,1976;Pynooset. .AL., 1987;Terr,1983,1991;Green et. at.,1991;Breslau et. at., 1991 )

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In anefforttostudyfurtherthe evolutionofthe psychologicaleffectsofdisasterwehaveundertakenastudyofelementary school age childrenwhoweredirectlyinthepathwayofhurricaneAndrew(HI-IMPACTSCH)and a comparable elementary school population northofMiami(LO-IMPACT SCH). METHODS One hundredfortyfourschool age(71boys,73girls) children 6-11 years (mean age8.2,S.D.1.55)wereevaluated.Atthe timeoftheinterview82(57%)ofthechildren were enrolledatHI-IMPACT SCH and62(43%) were locatedatLO-IMPACT SCH.Atthetimeofthehurricane62(43%)were enrolledatHI-IMPACT SCH,44(31 %)atLO-IMPACT SCH and residing intheirhomewith38(26%)enrolled in another school ornotresiding intheirhomeatthetimeofthehurricane. For the purposeofthisstudythe"other"groupwasexcluded leaving106childrenforour analysis. Table 1 presents various demographic variablesforeach school. As canbeseen from this table,thetwoschoolswerequite similar. One notable exception is grade placement, where asignificantchi-square was obtained indicatingthatthere isanunequal grade distributionbetweenthetwoschools. TABLE 1 PROCEDUREAteightweeksposthurricane the children were administered an instrument measuringthedegreeofseverityofexposuretothe hurricane and Pynoos's Post-traumatic Stress Disorder ReactionInventory(PTSDRI). In addition,thestudent'sprimary classroom teacher completedAchenbach'sTeacher's Report Form(TRF)on each child. The PTSDRI and the TRFwererepeatedat32weekspost-hurricaneforHI-IMPACT SCH.

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Pre-hurricane school year(1991-1992)and post-hurricane school year(1992-1993)data onthefrequencyof40measuresofovert andcovertdisruptive behaviorswereobtainedfromtheDadeCountyPublic Schools. However only21measuresofcovertand overt disruptive behaviorwereutilized in the presentstudybecauseofthelowprevalenceofelementaryschool children engaging in such behaviorsasgambling, concealing a weapon,extortion,selling, using or distributing mood modifying drugsetc.Data obtainedwerebrokendownbygrading periodforthepre-hurricane school year(1991-1992)and the post-hurricane school year(92/93)forHI-IMPACTSCHand LO-IMPACT SCH,aswellasforthebroader school regions Le. Region VI (HI-IMPACT SCH) and RegionII(LO-IMPACT SCH). MeasuresofOvertdisruptivebehavior included: General disruptive behavior, defianceofschool authority,disruptionon the school bus, assault,theft,vandalism,batteryon astudentorstaffmember,fighting,robbery, continuous disruptive behaviOl', damaging school property, and aggravated assault. MeasuresofCovert disruptive behavior included: Useofprovocative language,cuttingclass, dress code violation, excessunsatisfactoryabsences, in an unauthorized location, leaving classwithoutpermission, rude and discourteous, excessiveness tardiness, and trespassing. The proportionofstudents per student body reportedtothe schooldistrictforthecompositeovertand covert disruptive behaviorswerecomparedforthe year before andafterthehurricanewithingrading period. RESULTS The hurricane exposure instrument provided an easy straightforwardmethodofdeterminingtheseverityofexposuretothe hurricane (Appendix A).Asexpected students in HI-IMPACT SCH had asignificantlyhigher mean score (numberofpositive endorsements) (M =6.0,SO=2.1)thanstudentsin LO-IMPACT SCH (M =2.2,SO=1.9),1(115) =10.51,p=<.0001.,althoughthistrendwasnotuniversal. Table 2 presents the individualitemendorsementsforHI-IMPACT SCH and LO-IMPACT SCH alongwithsupporting chi-square

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tests. Theseverityofexposureforstudents in HI-IMPACT SCH is quite obvious,forexample,82%ofthestudentshad awindowbroken or doorblownopen;56.5%hadpartoftheroofblownawayorcavedin;87%reported being scaredthata loved onewouldbehurtofkilled,24%reported apethurtor killed and39%reported stayingoutoftheirhomeafterthehurricanewasover. Table 2 Pynoos(1992)categorizes severity onthePTSDRIwiththefollowingcriteria:Doubtful(score lessthan12), mild (score range12to24),moderate (score rangefrom25to39),severe (score rangefrom40to59), and very severe(ascore greater than60)with"themaximumscoreof80.Duetosparse data inthe comingency tables the PTSDRIwerecollapsedbycombining Doubtful-Mild and Severe-Very Severe. Table 3 presentsthePTSDRI endorsement frequenciesforHI-IMPACT SCH andLa-IMPACTSCH.Ascan be seenfromthis tablethegreatmajorityofstudents endorsed post-traumaticsymptomswith87%ofthechildrenatHI-IMPACT SCH and80%ofthe children atLa-IMPACTSCH endorsingatleast moderate levelsofpost-traumaticsymptomatologyas measuredbythisinstrument.Therewasnostatisticallysignificantdifference in PTSDRIsymptomatologybetweenthetwoschools. While a comparable percentageofstudentsatbothschools endorse MILD and MODERATEsymptoms,HI-IMPACT SCH hadtwiceasmanystudents intheSEVERE category.Whenthetwoschoolswerecomparedforage, ethnic and gendereffectstherewerenodifferencein post-traumaticsymptomatology.

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Table 3 OnAchenbach'sTeacher Report Form, T-tests indicatedthatthe boys at HI-Impact SCH-A hadsignificantlylowerscoresonthe Unpopular scale,(p=.05).However,T-tests identified severalsignificantdifferences on the TRF scales were observedforfemales. Females in HI-IMPACT SCHshowedsignificantlylowermean scores on Internalizing(p<.01),Externalizing (p<05),Anxious(p<.01),Unpopular(p<.01),Self-Destructive(p<.05),and Aggressive(p<.05)thanchildren in HI-IMPACTSCH(Table 4). Therewasan evident trendwithLO-IMPACT SCH demonstrating more psychopathologyasmeasuredbythe TRFwithHI IMPACT SCH exhibiting less indicesofpsychopathology. Table 4 Finally,at32weeksposthurricane,wewere abletorepeat the PTSDRI measures on64/65children previously tested in HI-IMPACT SCH. Therewasa statistically significant change in PTSDRIsymptomatology,X(4,N=64)=17.3,p<.005indicating a reduction inpost-traumaticsymptomatologysuggesting gradual recovery (Table 5). Nevertheless, 80% ofthestudentswerestill rated in the MODERATE andSEVEREtoVERYSEVEREcategories indicated continuing psychological distress. Table 5Atthe32weekre-evaluation only28TRFswere returned backfromtheschool. Therewerenostatisticallysignificant findings on the TRF scalesformales and only oneforfemales

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althoughthetrendin meansalwaysevidenced a higher valueatweekthirty-twoforboth genders.At32weeksposthurricane, femalesatHI-IMPACT SCHshowedasignificantlygreater mean score ontheUnpopular scale(p<.05).The lackofstatisticalsignificance ontheTRF islikelyduetolowpower.Nextweexaminedtherelative riskofobservingcovertandovertdisruptive behaviors reportedtoDCPSforboththeeducational regions where HI-IMPACT SCH (Region VI) and LO IMPACT SCH (Region II) are located andforeach school,foreach grading periodfortheschool yearafterthehurricane. School-based disruptive behaviorshoweda marked decrease(p<.0001)in prevalenceforbothovert and covert behaviorforthegrading periodimmediatelyfollowingthehurricane in Region VI (Figure1)buta marked increase(p<.0001) in RegionIIrelativetotheschool year preceding the hurricane (Figure 2). The decrease in RegionVI'sovertbehavior fellbacktotheprevious year's levelbythe second grading periodwhilecovertbehaviorsignificantlyrose(p<.0001)above the previous year's levelsforcovertbehaviors. Figures 1&2 Examiningthesame dataattheschool level reveals a simplerbutsimilar trend. Forthefirstand second grading periodsatHI-IMPACT SCH therewasa significant decrease inbothovertandcovertdisruptivebehaviors (p's < .05)afterwhicha significant increase inovertbehavior(p<.01)wasobservedwhilecovertbehavior returnedtotheprecedingyear'slevel. Thefourthgrading periodshowedthelevelsofovert behavior returningtotheprecedingyear'slevelsbutasignificantdecrease in covert behavior(p<=.05HFigure3).Thetrendsin LO IMPACT SCH,however,lookverydifferent. In LO-IMPACT SCH therewasasignificantincrease inthelikelihood of bothovert and covert disruptive behaviorsforthefirstthree

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gradingperiods(p's<.05)withlevels only returningtopreviousyear'slevels inthefourthgrading period (Figures 4) Figures 3&4 DISCUSSION Ourfindingsare in agreementwitha numberofstudiesoftheeffectsofdisaster on childrenwhichhavedemonstratedthatpsychological distress is correlatedwithproximitytothezoneofimpact(Blochet. gL" 1956,pynoos et. gL" 1987)Whatisofinterestisthatchildren in LO-IMPACT SCH hadthesame prevalenceofmild and moderate categoriesofposttraumaticsymptomatologyasdid children in the immediatepathwayofthestorm.This findingsuggeststheeffectsofmedia exposure, the pressofevacuation, emotional contagion, the peripheralimpactofthestormand the initialuncertaintyastowherethestormwouldstrikeprecipitatedconsiderable emotional responsivity inthecontrol group.Itis also possiblethatsinceourmeasureswereeightweeks post-hurricane these childrenwerereactingtotheconsiderabledisruptionin allofDade County andtheinfluxofadditionalstudentstothe"northernschools"duetotheflightoffamiliesoutofsouth Dade County. There is increasing awarenessoftheimpactofanticipatoryanxiety associatedwithan impending disasteronpost-traumaticsymptomatoloy.Kiser et. al. (1993) have describedtheeffectsofanticipatoryanxietyininitiatingmildand moderate post-traumaticsymptomatologyin a groupofschool childrenwhoweretoldthatan earthquake wouldoccurwhichinfactnever happened. HIIMPACTSCHwastwiceaslikelytohave childrenwhowererated "severetoverysevere" intheirendorsementofpost-traumaticsymptomatology.Thisfinding is congruentwiththeseverityofexposure andtheproximitytothe eyeofthestorm.Whilepost-traumaticsymptomsat32weeksweresignificantlyreduced comparedto

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theperiodimmediatelyfollowingthehurricane,thelevelofsymptomatologyremained high. The high prevalenceofPTSat32weeks post-hurricane,webelieve is duetothe secondaryeffectsofthedevastationwroughtbyHurricaneAndrew.Thefailuretonote a gender, grade and ethniceffectonthePTSDRI iscongruentwithPynoo'sstudyofa school population following a sniperincident(1987).The failuretodelineate a gendereffectalongthelines suggestedbyGreenetai,(1991)and Breslau et.aJ.(1991)mayreflecta relative insensitivityoftheinstrumenttogender differences. Themostinteresting finding is the documented reduction inthemanifestationsofnon PTSDRIemotionaland behavioral problems in the immediateaftermathofthehurricane intheschoolslocatedinthezoneofimpact. The findingthatHI-IMPACT SCH inthepathwayofHurricaneAndrewmanifestedreduced indicesofpsychopathologyonAchenbach'sTeacher Rater Form comparedtoLO-Impact SCH-B, moresignificntlyforfemales; andconcomitantlymanifestedsignificantlyreduced reported overt andcovertdisruptive behavior comparedtoLO-IMPACT SCH andtheprevious year's levelofdisruptive behavior iswebelieve duetoa generic shock-like, numbingeffectin the immediateaftermathofthe hurricanewhichdampenedthebehavioral responsestothe disaster. Resultsfromananalysisofall39schools in Region VIconfirmedthis findingthatfollowing the storm therewasan initial and significant reduction inovertandcovertdisruptive behaviors comparedtoRegionII(37 schools),northofMiami and comparedtotheprevious year's levelofdisruptive behaviorforalltheschools. There is evidencethattheinitial decline in non-PTSDRI emotional and disruptive behaviors in HI-IMPACT SCH and its larger educational area, Region VI, isfollowedbya reboundeffectwhichisfollowedbya relative quick returntonormalcy.Webelievetherelativequickreturntolevels congruentwiththe previous years indicesofdisruptive behaviors is associatedwiththesignificantinvestmentofmental health professionals, crisis mobileteamsandtheintroductionofcrisis intervention specialistsintotheschoolswhich

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commencedinNovember1993.Contrarily,therewasa reported increase in overt andcovertdisruptive behaviors and seemingly increased levelsofpsychopathologyasmeasuredbytheTRFatla-IMPACTSCH anditslarger school region, RegionII(northofMiami) inthefirstgrading periodfollowingthehurricane.Thisseemstobe relatedtoa numberoffactors. OneofthemostimportantisthattheflightofrefugeesfromSouthDade resulted in a6%increase intheschool population in RegionIIand a13%increase inthelOW-IMPACTSCHwithincreased demands on limited resources.Anothervariablewasa relatively lesseningofmental health resources as forces weremartialedtoprovide assistancetothe schools in Region VI and other schools (southofMiami)locatedinthepathwayofthe storm.Itis apparentthatovertandcovertdisruptive behaviors remained high innorthMiami throughoutmostoftheschool year subsequenttothehurricanewithonlya gradual return to normalcy bytheendofthe school year. This finding suggeststheneedformental health professionalstoberesponsivenotonlytothevictimsofdisasterbutthederivativeeffectsonsurrounding communities.Wespeculatethattheinitial high levelsofPTSDRIsymptomatologyresonateswiththe"event"trauma.Theimpactofa sudden, unexpectant,wellcircumscribed stressor like a hurricanewithitsbodilyand lifethreatprecipitates characteristicpost-traumaticsymptomatology. Theinitialdisasterwasfollowedbyanarrayof"secondarystressors".The continuing high levelofPTSDRIsymptomatologyat32weekswebelieve is relatedtotheemergenceofa"process"trauma.(Terr,1991).Theeffectofthehurricanewastodestroytheinfrastructureofacommunitywithhigh unemployment,100,000dwellings rendered uninhabitable,theexodusofa large proportionofthepopulation,thelossofelectricity,telephones and logisticalsupportsystemsformanymonths.The initial hopefulnessofrecoveryfollowingtheinputoffederal resourceswasfollowedbyincreasing pessimism as familiesstruggledwiththeinherent adversarial relationshipwithinsurance companies,

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Table 1 DEMOGRAPHY HI-IMPACTSCHandLa-IMPACTSCH HI-IMPACT SCHLD-INPACTSCH Males3719Females25 25Racial/EthnicWhite2514Black1011Hispanic2414Other3 5Primary Language English5240Spanish8 3Other1 1Grade First149Second208Third4 4Fourth1617Fifth176LivewithMotherYes5643No5 1livewithFather Yes4229No1915 Chi-square=11.28, Q <.05

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rable 2 -furricane damageexposureforSCH-Aand SCH-B IN 1061. HI-IMPACT LO-IMPACT ItemSCHSC )(2 Doors orwindowsbreakorcomeopen? 51182.3%)5(9.6%)51.91<.0001Roofblownawayorcavein?35(56.5%)2(2.6%)30.52<.0001Didyougethurt?3(4.8%)1(2.3%)0.47NSIDidanyonewithyougethurt?10(16.1%)0(0.0%)7.84.005Wereyou scaredthata loved onewouldbehurt/killed? 54(87.1 %)29(65.9%)6.80.009Didyou see anyonegethurt?7(11.3%)2(4.6%)1.51 NS,Wasanyonewithyouveryscared? 54(87.1 %) 3,0(68.2%)5.60.018Didyougetwetfromrain/seawater?36(58.0%)6(13.6%)21.23<.0001Went outside duetodamagetohome?8(12.9%)1(2.3%)3.74<.053Didapetgethurtordie?15(24.2%)2(4.6%)7.38.007Stayoutofyourhomeafterthehurricane?24(39.3%)4(9.1 %)11.96.001Areyou stilloutofyourhome?12(19.4%)0(0.0%)9.60.002Didagrownuplosehis/herjob?15(24.2%)3(6.8%)5.51.019Didyou loseanythingimportant?25(40.3%)11(25.0%)2.69NSDidyourfamilygetseparatedforawhile? 5(8.1 %) 1(2.3%)1.62NSDoyou feel safe sincethehurricane? (No responses)9(14.5%)2(4.6%)2.75NS Troublegettingfoodorwater?24(38.7%)14(31.8%)0.53NS--------

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Table 3 Comparisonofpost-traumaticsymptomatology in HI-IMPACT SCH and LO-IMPACTSCHDegreeofSymptomatologyDoubtfultoMildModerate SeveretoVerySevere HI-IMPACT SCH8(12.9%)19(30.7%)36(56.5%)LO-IMPACT SCH9(20.5%)18(40.9%) 17(38.6%)

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Table 4 Means and standard deviationsfortheTRFby school gender Males Females HI-IMPACT LO-IMPACT HI-IMPACT LO-IMPACT SCHSCHSCH SCH Internalizing1.92(2.764.31 (5.652.92(5.20)9.15(8.19Externalizing10.27(13.6517.38(18.426.64(8.63)16.85(20.13)Anxious0.92(1.67)2.5(3.33)1.56(3.37)6.20(5.52)SocialWithdrawn1.00(1.41)1.81 (2.99)1.36(2.53)2.95(3.49)Unpopular0.70(1.05) 1.75(1.810.76(1.30)4.30(4.74)SelfDestructive0.41(0.86)0.56(0.73)0.28(0.54)1.20(1.64)Obsessive-Compulsive0.77(1.061.13(1.36)0.08(0.28)0.30(0.73)Inattentive4.68(5.32)7.69(7.52)3.96(6.23)6.60(8.56)Nervous -Overactive0.81(1.17)1.38(1.41 )1.00(1.44)1.80(1.99)Aggressive4.78(8.89)8.32(11.02)1.68(2.30)8.45(11.51)

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Table 5 HI-IMPACT SCH A: PTSDRISvmptomatology8 Weeks DOUBTFUL-MILD MODERATESEVERETO VERY SEVERE12232932Weeks1327,24

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Figure 1REGIONVI;OVERT&COVERTDISRUPTIVE BEHAVIORFORTHEPOSTHURRICANESCHOOLYEARBYGRADING PERIOD Relative Risks1.251.201.151.101.05 1.00 .05.90 .85.80.75 Period 1 OvertPeriod2Period3 CovertPeriod4

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Figure 2REGIONII;OVERT&COVERTDISRUPTIVEBEHAVIORFOR THEPOSTHURRICANESCHOOLYEARBYGRADING PERIOD Relative Risk1.60 1.50 1.'10 1 1.201.10 1.0.90 .80Period 1 OvertPeriod2Period3 CovertPeriod4

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FIGURE3 HI-IMPACT SCHA's OVERT&COVERT DISRUPTIVE 6EHAVIOR FOR THE POST HURRICANE SCHOOL YEARBYGRADING PERIOD Relative RiskI7,.Jfl.b.Itr.,'1.02.5 2.01.51.0.5aPeriod 1 Period2Overt17.-3Period 3 CovertPeriod4

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;. ................ (-.,. ...." :,-. :,(.;4" FIGURE4 LO IMPACT SCH-B's OVERT&COVERT DISRUPTIVE BEHAVIOR FOR THE POST HURRICANE SCHOOL YEARBYGRADING u.n 7.0 B.O(LO 4.02.01.03.0 s.O Relative Risk 00.0, .. '; 12.8187.97oPeriod 1OvertPeriod2Period3 Covert Period 4.

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REFERENCESAdams,P.R.&Adams,G. R.,(1984)MountStHelen'sAshfall,AmericanPsychologist,39:252-260.Bloch, D.A.,Silber,E., & Perry, A.B.,(1956)SomeFactorsintheEmotionalReactionofChildrentoDisaster,Am.J.Psychiatry,113:416-422.Burke,J.,Moccia,P., BorusJ.&Burns, B.,(1986)EmotionalDistressinFifthGrade ChildrenTenMonthsafteraNaturalDisaster,J.Am.Acad.ChildAdolesc.Psychiatry,536-541.Erikson, K.,(1976)LossofCommunalityatBuffaloCreek,Am.J.Psychiatry,133:302-305.Green, B.L.;Korol,M.,Grace,M.et.aI.,(1991)Children andDisaster:Age,Gender, and ParentalEffectsonPTSDSymptoms,J.AmAcad.ChildAdolesc.Psychiatry,30:945-951.Kiser, L.,Heston,J.,Hickerson,M.S,et. aI.,(1993)AnticipatoryStressinChildren andAdolescents,Am.J.Psychiatry,150:87-92.Lifton,R.J.&Olson,E.,(1976)The Human MeaningofTotalDisaster,Psychiatry,39:1-17.Newman,C.J.,(1976)ChildrenofDisaster: ClinicalObservationsatBuffaloCreek,Am.J.Psychiatry,133:306-312.Terr, L.C.,(1991)ChildhoodTrauma:AnOutline andOverview,Am.J.Psychiatry;148:1020.Terr, L.C.(1981)PsychicTraumain Children: ObservationsfollowingtheChowchillaBusKidnapping,Am.J.Psychiatry,138:14-19.Terr, L.C.(1983)Chowchillarevisited: theeffectsoftraumafouryearsaftera school bus Kidnapping,Am.J.Psychiatry,140:1543-1550.Terr, L.,1991,ChildhoodTraumas:AnOutline andOverview,Am.J.Psychiatry,148:1-20.Pynoos, R.,&Nader,K.,(1988)Psychological FirstAidandTreatmentApproachtoChildren ExposedtoCommunityViolence:ResesrchImplication,JournalofTraumaticStress,Vol.1,pp413-430.Pynoos,R.,Frederick,C.,Nader,K.,et.ai,(1987)LifeThreatandposttraumaticstressinschoolagechildren,Arch.Gen. Psychiatry,44:1057-1063.Pynoos, R.(1993)PersonalCommunication.

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Appendix AWHATHAPPENEDTOYOUDURING AND AFTER THEHURRICANE?1.0. # _1.Where were you during the hurricane? (You can checkmorethan one) in my home in a closet in a friend'sorrelative's home ina bathroom in a shelter in acarsleepingoutoftown7. Did you see anyone hurt badly during the hurricane? 11. Did apetyou liked gethurtordie during the hurricane? 18. Did you have to gotoanewschool becauseofthe hurricaDe? 3. Did partorallofyourroofget blown awayorcaved in?YesNoYesNoYesNoYesNoYesNoYesNoYesNoYesNoYesNo Yes No Yes No Yes NoYesNo Ya No Yes NoYesNoYesNoYesNo...Did anyone with you gethurtduring the hurricane? 4. Did you get hurt during the hurricane?5.a)Ifyes, how many days/weeks were you out b)Areyou stilloutofyour home? 9. Did you get wet from rainorsea water during the hurricane? 6. Did you get very scared that youorsomeone you love 'would get hurtordie during the hurricane? 8. Was anyone with you very scared during the hurricane? 2. Did any windowsordoors break orcome open in the place you stayed while the hurricane was here? 10. Did you have to go outside during the hurricane becausethebuilding you wereinwas badly damaged? IS. Didyourfamily havetobe separated for a while? 12. After the hurricane, didyouhaveto stay outofyour home for awhDe? 16. Did you feel safeinthe places you have stayed since thehurricme? 13. Did a grownup in youhomelose hisorherjob becauseoldiehurricaDe? 14. Did you lose anything really important to youbecauseof thebarricaDe? 17. Did youoryour familyhavetrouble getting enough food aDdwater after the hurricane?