In 2005, Hurricane Katrina displaced hundreds of thousands of people, possibly more, and in the following two years, Shannon Self-Brown kept up with more than 400 of them.
Self-Brown, now the chair of the health-policy-and-behavioral-sciences department at Georgia State University’s School of Public Health, and her fellow researchers wanted to better understand how parents and children coped with having lived through a natural disaster. She found that in addition to being physically disruptive, Katrina—along with Hurricane Rita, which followed a month later—was psychologically disruptive, too, affecting some children even years later. “You really see similar impacts from tornadoes, flooding, earthquakes, even man-made disasters [like] 9/11,” Self-Brown says.
On Thursday, as Hurricane Florence was on the cusp of making landfall, I spoke with Self-Brown about natural disasters’ psychological effects on families, as well as how children make sense of why natural disasters happen. The conversation that follows has been edited and condensed.
Joe Pinsker: As your and others’ research indicates, having a storm damage one’s home can be traumatic. What difficulties do young children have when trying to make sense of that, and how would you think about working through those difficulties with a child?
Shannon Self-Brown: It’s a hard thing to understand for anyone, even adults. It’s hard to make sense out of why this has happened—Why am I impacted? Why me?
A lot of what you’d say would depend on the developmental age of the child, but really, the goal in any kind of trauma work is to first lay out for the child that this is okay to talk about, because a lot of times the natural thing for people to do is avoid talking or thinking about it, which actually can make post-traumatic-stress symptoms worse.
Then you want to work with them on how to process it. For a lot of kids, processing a trauma is handled with what we call “gradual exposure,” where you see what kind of activities a child might be interested in, whether they want to create a book or a rap or a poem that helps them gain control over the story. And then you want to look for what might be the places in the story where a child is blaming themselves. Children have a really interesting way sometimes of processing these things. They might, because of their developmental level, think, “I did this bad thing in school yesterday and that’s why this happened to my family.” You just never know how they’re processing it, so you want to get to the irrational beliefs that might be maintaining the anxiety and the fear, and help them correct those. And through the telling of the story and the correcting of the irrational beliefs, that’s how you get to healing.
Pinsker: And how does this approach vary based on a child’s age?
Self-Brown: The evidence-based therapies that exist for trauma tend to start around age 4. The idea is that around age 4 they can start going through these processes of gradual exposure, where you try to have those corrective conversations to help them understand that it wasn’t their fault and that while this did happen to them, it’s relatively rare. Giving them factual information like that, helping them understand that they’re not the only person who experienced this, that other children are going through this, making them feel not alone—those are all kinds of things that can help them cope.
I think prior to age 4, what you want to focus on is the functioning of the parent. If a parent came to me with a young child and said, “My child’s just been so clingy since the storm,” or, “They’re having lots of stomach aches”—things that suggest anxiety—but they aren’t really old enough to articulate their experiences or these other things that you need to be able to have a little more of a talk therapy about, then the focus would be on working with the parent: How are you coping? How’s your mental health? What are your routines with your child? How are you handling self-care?—thinking about what you’re modeling for your child and how you’re promoting stability with them. With younger children, as long as they feel like their parents are okay, they’re going to be okay.
Pinsker: What did you find when you followed families affected by Hurricanes Katrina and Rita?
Self-Brown: I think the most innovative finding that we have is from a paper that we published along with Dr. Betty Lai, who is now at Boston College, looking at something that hadn’t been studied a lot, which is, what are the different long-term psychological trajectories for young people who have lived through a storm, and do those change over time? The paper included 426 youth, and we followed them across four time points after those two storms.
We essentially found three trajectories that youth tended to cluster in related to post-traumatic stress. About 71 percent of youth, the majority of them, were resilient, meaning that they didn’t have any stress symptoms, and they just stayed there for the two-year period. And then about a quarter of the youth were in what we called a “recovering trajectory,” so they initially met the criteria for PTSD—but over time, as you would expect, they just kind of got better.
However, the third group, which was about 4 percent of the sample, we classified as a chronic group. And those youth had PTSD immediately following the storm, and it stayed at that high level for about a two-year period. Our last follow-up time point was two years post-disaster, so we’re not certain about after that.
When I say PTSD criteria, I’m referring to the clinical symptoms you would need for a PTSD diagnosis. PTSD is a stress reaction to an event where you had extreme stress and either felt very threatened or vulnerable, or thought that you might die. And some of the hallmark symptoms are hyperarousal (a youth might have a really hard time paying attention or being calm) and reexperiencing (maybe the youth, when a slight rainstorm comes, for instance, after the hurricane, that might cause them much more stress than a typical rainstorm should).
Pinsker: Were there any things that made children more likely to fall into one group or another?
Self-Brown: One is that, as you’d expect, youth who had the most significant exposure to the hurricane were more likely to be in that chronic category than others. But also, youth who had been exposed to more violence in their communities had increased risk too—it’s often not only the experience of the disaster itself, but it could be other types of trauma that play into that poor long-term outcome. But on the positive side, we found that youth who really found a strong peer group and received good social support from them—that was a protective factor.
Pinsker: So if you were trying to help kids cope with natural disasters, how might you try to help them with their social-support systems?
Self-Brown: That’s a great question, and I think that’s something that people are still really working on. Because there’s so much displacement and disjointedness after hurricanes, there may be a loss of a peer group, because you may be starting in a new school and living in a new community. So how do you develop really strong peer relationships in a new area? I think that’s what we know the least about. What is a little more straightforward is that when communities are able to stay together, you can put programs in schools that help youth share their experiences, perhaps tell stories, and that open up a dialogue about what happened.
Pinsker: In the lead-up to a natural disaster, there’s a focus on evacuation procedures and telling people what practical things they should make sure they have with them. Are there similar initiatives around people’s mental health?
Self-Brown: There is—there’s a national organization, the National Child Traumatic Stress Network, which is administered by the federal government. Its whole purpose is to prevent and intervene with traumatic events with children and families. Its website lists things to be thinking about before, during, and after a hurricane, which can really help parents and children cope with a natural disaster. I do wish that those kinds of resources would be just as publicized as putting together your emergency kit. It’s important to have kids bring a special toy when you’re packing, or come up with things to do, things to distract them, so you’re not sitting there focusing all your energy on something you can’t control. I know it’s hard to prioritize those kinds of things when you’re fearing the worst, but if you can do a little planning around how to promote positive ways of dealing with this stress, then it’s going to be much better for you and your family in the long term.