Abstract
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Although childhood is often characterized as a carefree and happy time, it is estimated that between one quarter and two thirds of children are exposed to a traumatic event prior to adulthood. Not a day goes by without news of natural disasters, terrorism, crime, or war somewhere in the world; these events are often associated with life threat, and their psychological impact on children and their parents can be devastating. Fortunately, the medical community can refer to Care of Children Exposed to the Traumatic Effects of Disaster to learn about the psychological impact of disasters, stress, and trauma on children. This compelling text describes the typical psychological responses to trauma at each developmental level, in addition to the significance of trauma coupled with bereavement.
How does the material in this book translate into meaningful intervention for children? By educating the community (including volunteers and mental health and primary care clinicians), about the significance of trauma on a child's life, it facilitates an appreciation of what to look for and how to intervene. Until I cared for the 8-year-old girl who survived a plane crash (Webb 1991) I did not fully understand the role that the disaster mental health provider serves. Until I listened to the stories of countless victims of traumatic experiences, I did not fully appreciate the various ways in which children and adolescents cope. Although I have come to expect resiliency, I have developed a keener respect for the diverse ways in which prior life experiences impact the response to current traumatic events.
Do mental health providers recognize the importance of understanding this information? By describing the impact of trauma on youth, this volume serves as a guide for appropriate therapeutic interventions for a traumatized child or family. Psychological reactions to chronic ongoing stress in the life of a child or adolescent may differ from the reactions to acute stress. A clear distinction between the definition of acute and chronic stressors is provided. This facilitates an understanding of the range of therapeutic responses that should be offered by a helping professional depending upon the circumstance. The importance of differentiating among traumatic events, traumatic reminders, and cumulative risk helps the clinician recognize and understand the impact of specific types of traumas on the child, and informs treatment planning.
Did families ignoring evacuation warnings understand the possible life-threatening impact on them and their children? Hurricanes, tornadoes, and earthquakes are but three examples of natural disasters that cause devastation and traumatic impact on youth. It is appropriate, therefore, that natural and human-generated disasters are described here to clarify the scope and scale of an event, and its psychological effects on the pediatric population. For example, human-generated disasters can be either intentional or unintentional. Each has a different meaning. Intentional events elicit a particularly unique outrage. Multidimensional disasters combine features of natural, as well as human-generated unintentional disasters. Understanding each of these categories and their varied implications enables the clinician to recognize and appreciate appropriate interventions needed to begin the process of healing. The inclusion of clinical case examples, therefore, is a suggested enhancement of the book in future editions.
Shaw, Espinel and Shultz elaborate on the critical contribution of resilience to recovery from trauma. They also explore the role of the family and the reactions of the adults responsible for the care of children after a traumatic event, as well as offering guidance in assessing these issues. The discussion of psychological first aid (PFA) highlights the importance of supporting the adults in a family in order to enhance the adaptation of their children. A distraught parent may have distraught children.
The review of how to recognize the signs and symptoms of posttraumatic stress disorder (PTSD) at various developmental levels is another invaluable strength of the book. Distinctions between criteria of PTSD in Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-V) and those in Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM IV), keeps the contents of this book up to date (American Psychiatric Association 1994, 2013).
If a child survives a plane crash and loses her mother, how does the clinician proceed? Traumatic bereavement requires an appreciation of the way that children perceive loss. Loss of a loved one can have a dramatic and permanent meaning for a child. Shaw and colleagues review PFA as well as a range of clinical interventions for youth facing complex loss.
The structure and format of the book is easy to read and user friendly. In a thoughtful and well-organized fashion, the reader is offered a highly valuable summary of current knowledge regarding the impact of trauma on children. There is a large amount of information, and it requires careful reading. The intervention section provides an enormous amount of invaluable information. For those interested in caring for children exposed to the effects of trauma, this volume will serve as a valuable road map and reference. It is also of note that references throughout the text are up to date and relevant.
In summary, Care of Children Exposed to the Traumatic Effects of Disaster is well written, clear, concise, and practical. This volume, which is authoritative and comprehensive, will become essential reading for the interested student or clinician working with children. Information that the reader will not find in this book simply represents the limitations in our knowledge of this field. For example, research may help to clarify the neurobiological impact of trauma and disaster on brain functioning. This may lead to more specific treatment interventions. It remains to be clarified which biological factors are protective. A future edition may be able to discuss these unanswered questions, as psychiatric diagnosis moves away from a descriptive review of symptoms to a more biologically driven etiological framework.
This book will take a proud place in an extant literature on this subject, including Terr's inspiring work Too Scared to Cry (1990), Boyd Webb's Play Therapy with Children in Crisis over the past 20 years (Webb, 1991, 1999, 2007), Pfeffer's highly regarded text Severe Stress and Mental Disturbance in Children (1996), and Danieli, Brom and Sills' The Trauma of Terrorism: Sharing Knowledge and Shared Care, An International Handbook (2005), to name a few. As the exploration of the impact of trauma on children gains increasing attention, Shaw, Espinel and Shultz's work arguably represents the most up-to-date and comprehensive review of this material.
In addition to the traditional mental health clinician, psychiatry residents and child and adolescent psychiatry fellows, as well as community rescue personnel, will also find this resource a useful and practical guide to the understanding of the impact of trauma and disaster on children. Shaw, Espinel and Shultz have now added an important resource to the existing body of literature on this topic.
Footnotes
Disclosures
No competing financial interests exist.