NDSU Department of Child Development and Family Science
North Dakota Department of Human Services
October 1998
Hollie K. Berglof, Box 8380, University of North Dakota, Grand Forks, ND 58202-8380, Phone: (701) 795-8528
Andrea A. Zevenbergen, Assistant Professor of Psychology, Box 8380, University of North Dakota, Grand Forks, ND 58202-8380, Phone: (701) 777-3017, Fax: (701) 777-3454
This study examines preschoolers' behaviors subsequent to the 1997 Red River Valley Flood. Assessment of preschoolers' behavior problems was conducted within the 8 weeks previous to the flood and 6 weeks after the flood. Results indicated a decrease in preschoolers' activity level and an increase in their crying post-flood. Trends were found for increased emotionality and difficulty concentrating post-flood, as well as changes in children's getting ready for bed, getting ready in the morning, and teasing of other children. Findings are discussed in the context of the extant literature regarding the impact of disaster on preschoolers. Recommendations are provided for intervening with preschoolers subsequent to disasters.
Within the past few decades, research has begun to examine the effects of disaster upon children's behavior. Studies have assessed the effects of such tragic events as hurricanes (Sullivan, Saylor, & Foster, 1991), tornadoes (Seroka, Knapp, Knight, Siemon, & Starbuck, 1986), earthquakes (Guerin, Junn, & Rushbrook, 1991), lightning strikes (Dollinger, 1985), and floods (Burke, Moccia, Borus, & Burns, 1986). The vast majority of research in this area has been conducted with school-aged children and adolescents (e.g., Burke et al., 1986; Earls, Smith, Reich, & Jung, 1988; Jeney-Gammon, Daugherty, Finch, Belter, & Foster, 1992; LaGreca, Silverman, Vernberg, & Prinstein, 1996); preschool-aged children have thus far been relatively neglected in the research literature.
The purpose of this paper is threefold: First, this paper provides a summary of the literature regarding preschoolers' psychological responses to disaster. This literature review may alert parents, early childhood educators, and other caregivers to typical behaviors of preschool-aged children subsequent to disasters. Second, this paper describes the results of a study of preschoolers' behavior six weeks subsequent to the 1997 Red River Valley Flood. Third, this paper summarizes the clinical literature providing recommendations for intervening with preschoolers subsequent to a disaster. This information may assist caregivers in aiding preschoolers' adjustment following disasters and other traumatic events.
One of the most frequent responses of preschoolers to experiencing disaster is anxiety about separation from caregivers. In one study following an earthquake, the most frequent problem for 3-6-year-old children was fear of being alone (Blaufarb & Levine, 1972). Similarly, separation difficulties and clingy, dependent behavior each were reported in 67% of the calls about children (who were mostly preschoolers) to a mental health hotline in the two weeks following the 1989 Loma Prieta earthquake (Ponton, Bryant, & DiClemente, 1991). Other studies (Guerin et al., 1991; Kalayjian, 1994; Ponton & Bryant, 1991; Saylor, Swenson, & Powell, 1992; Sullivan, Saylor, & Foster, 1991) have reported separation fears in preschoolers subsequent to disasters as well. According to Bowlby (1969), young children look to the caregiver as a "secure base." The general tendency for young children to stay closer to an adult in unfamiliar or potentially stressful circumstances (Bowlby, 1973; Robertson & Robertson, 1989) may be increased during a particularly stressful event such as a disaster (Vogel & Vernberg, 1993).
In addition to separation anxiety, preschoolers may exhibit other fears following a traumatic event. Some parents have reported significant storm fears (Seroka, Knapp, Knight, Siemon, & Starbuck, 1986; Sullivan et al., 1991) and fears of animals (Sullivan et al., 1991). After Hurricane Hugo, some preschoolers showed fear of water, extending in some cases to refusals to take baths or showers (Saylor et al., 1992). Preschoolers have also been reported to fear going to sleep in their own room following a disaster (Blaufarb & Levine, 1972; Gordon & Wraith, 1993); this fear may be related to an overall fear of separation from caregivers.
Bedwetting is also commonly seen in preschoolers subsequent to disasters. Durkin, Khan, Davidson, Zaman, and Stein (1993) reported a signficant increase in bedwetting in children aged 3-8 from 6 months prior to a flood to 11 months subsequent to the flood; this increase is notable as the occurrence of bedwetting usually decreases as children get older. Other researchers have also identified increases in bedwetting in preschoolers subsequent to disasters (e.g., Gleser, Green, & Winget, 1981; Milne, 1977; Perry, Silber, & Bloch, 1956).
Play reenactment of the traumatic event is another behavior that has been reported in preschoolers following a disaster. Terr (1981) observed a 5-year-old girl burying her dolls after being involved in a school bus kidnapping in which the victims were held in a buried tractor-trailer. Similarly, preschoolers were reported to reenact through play events related to Hurricane Hugo (Saylor et al., 1992). Play reenactment may be indicative of either poor adjustment to the traumatic event, or a "working through" of the experience, depending upon the repetitiveness of events within the play reenactment (Terr, 1981). Repetition of events without any alterations in the reenactment over time is often indicative of emotional difficulties in the child, whereas progression in the reenactment often reflects good emotional adjustment. As one example of progression in play reenactment, many preschoolers' play subsequent to Hurricane Hugo progressed from blowing houses down to acting out the role of roofers rebuilding houses (Saylor et al., 1992).
Other symptoms seen in preschoolers subsequent to disasters include distractibility, hyperactivity, impulsivity, aggressiveness, demanding behavior, frustration, irritability, temper tantrums, antisocial behavior, sleep difficulties, nightmares, thumbsucking, withdrawal, dependency, somatic complaints, and emotional constriction (Burke, Borus, Burns, Millstein, & Beasley, 1982; Green et al., 1991; Kalayjian, 1994; Sullivan et al., 1991; van der Kolk, McFarlane, & Weisaeth, 1996). As can be seen by this extensive list, there is significant variability in preschoolers' responses to experiencing disasters; parents and other caregivers should anticipate that preschoolers will respond to disaster experiences in many different ways.
It is difficult to estimate from the literature the percentage of preschoolers who respond to disasters with behavioral symptoms. No epidemiological studies have been conducted assessing the prevalence of symptomatology in preschoolers post-disaster. Some suggestion of prevalence rates comes from studies conducted by Kalayjian (1994) and Sullivan et al. (1991). Kalayjian reported that 86% of the children (aged 7 and younger) in his study displayed at least four behavioral symptoms subsequent to an earthquake disaster. Sullivan et al. provided information regarding symptoms that at least 50% of the 278 preschoolers in their sample experienced subsequent to the disaster. Sullivan et al. also indicated that 67% of the parents in their sample described additional symptoms in their preschoolers that had not been included on the questionnaire administered by Sullivan et al. Taken together, these studies suggest that subsequent to disaster, the majority of preschoolers demonstrate some behavioral symptoms.
Researchers have examined factors that appear to increase the risk of children experiencing symptoms subsequent to disaster. Two factors that have been identified as significant are parental response to the disaster and the proximity of the child to the disaster. Few studies have examined these factors in relation to preschoolers' response to disaster; studies conducted with older children are informative, however. According to Green et al. (1991), parental disaster response is a good predictor of how preschoolers as well as older children will respond. Several researchers (Bromet, Hough, & Connell, 1984; Earls et al., 1988; Gleser et al., 1981; Green et al., 1991; McFarlane, 1987; Richman, 1992) have found that the severity of responses of children generally correlate with that of their parents. Pynoos, Goenjian, and Steinberg (1995) described that highly traumatized parents may compulsively describe images of the traumatic event, increasing their children's distress.
Substantial research has suggested that degree of proximity to a traumatic event may be strongly associated with children's stress responses. Burke et al. (1982) found that preschoolers who lived closer to a flooded area showed significantly more antisocial behaviors than preschoolers who lived farther from the flooded area. Guerin, Junn, and Rushbrook (1991) found that the extent to which their homes were damaged was signficantly related to the severity of preschoolers' behavioral symptoms subsequent to the Loma Prieta earthquake. Similarly, Bradburn (1991) reported that children who lived closer to areas heavily damaged by the Loma Prieta earthquake were more likely to experience a greater degree of stress than children who lived farther away. Congruent results were obtained by Pynoos et al. (1987), who found that the severity of post-traumatic stress disorder (PTSD) symptoms in children was related to the distance children were from a sniper attack at their school. Taken together, these studies suggest that the extent to which preschoolers are exposed to a disaster, the more at risk the preschoolers may be to developing behavioral symptoms subsequent to the disaster.
Due to the unpredictability of natural disasters, much of the literature on disaster effects relies solely on data collected following a disaster. The problem with this type of methodology is that it does not adequately control for problems existing prior to the disaster. That is, possessing information regarding children's behavior only subsequent to a disaster, researchers cannot be sure that children did not also demonstrate similar problems before the disaster.
Only two studies involving preschoolers affected by disaster have observed children's behaviors before and after a disaster. In one of these studies, Durkin et al. (1993) observed children's behaviors before and after a flood disaster in Bangladesh. Participants in this study included children aged 2-9. Results indicated that the prevalence of both aggressive behavior and enuresis rose sharply after exposure to the flood disaster. One limitation of this study is that researchers did not present data regarding specific age groups; thus, it is unknown how the preschoolers specifically responded to the disaster. Burke et al. (1982) assessed children's behavior before and after a severe winter storm and subsequent flooding. Subjects were 15-48-month-old children who were enrolled in a Head Start program. Results indicated an increase in aggressive behavior and conduct problems subsequent to the flood. Although this study examined preschoolers' behavior both prior to and subsequent to the flood, pre-flood data were obtained approximately six months before the disaster and post-flood data were obtained five months after the disaster. Thus, although the study design permits inferences regarding changes in children's behavior resulting from the disaster, the length of time between the disaster and the assessment periods renders firm conclusions untenable. It is possible, for example, that the changes in the preschoolers' behavior resulted from an event other than the disaster (e.g., maturation, different classroom setting).
The present study investigated parental report of preschoolers' behavior approximately 2-8 weeks prior to and 6 weeks following the 1997 Red River Valley Flood. The 1997 Red River Valley Flood had a great impact on adults and children alike, devastating the communities of Grand Forks, North Dakota, and East Grand Forks, Minnesota. The flooding disaster began in Grand Forks and East Grand Forks on April 18, 1997. By April 21, 9,000 people (over 99% of residents) had evacuated from East Grand Forks and approximately 40,000 people (80% of residents) had evacuated from Grand Forks (Bakken, 1997). Although some residents were permitted to return to Grand Forks for short periods of time by April 24 and to East Grand Forks by April 27, the majority of residents remained evacuated until at least 3 weeks subsequent to the disaster. Approximately 75% of the homes in Grand Forks were impacted by the flooding, as well as 99% of homes in East Grand Forks. Repair costs for Grand Forks and East Grand Forks were expected to exceed $1.1 billion (Pioneer Press, 1997). The Red River Valley Flood was declared a "Level 5" disaster, the highest possible magnitude of disaster.
In the present study, it was hypothesized that preschoolers would show an increase in behavior problems after the flood disaster. Based upon the literature regarding preschoolers' behavioral responses to disaster, it was specifically hypothesized that the preschoolers would show increased concern about separation from caregivers. It was also hypothesized that those preschoolers who experienced more exposure to the disaster would demonstrate significantly more behavioral symptoms than preschoolers who experienced relatively less exposure.
Subjects were 12 preschool-aged children who lived in Grand Forks, ND, or the Grand Forks area in the spring of 1997. Eight subjects lived in Grand Forks, one subject lived in East Grand Forks, and three subjects lived in communities within 15 miles of Grand Forks. Sixty-six percent of the subjects were female. The average age of the subjects was 4 years, 2 months (range = 37 - 64 months).
All subjects in the present study had participated in a study regarding parent-child interactions within the 8 weeks prior to the flood. As part of this initial study, mothers of the preschool-aged subjects completed questionnaires regarding their child's behavior. Approximately 4 weeks subsequent to the flood, mothers of the children were contacted by mail and asked to again complete questionnaires regarding their preschool child's behavior. All participants from the first study agreed to provide data subsequent to the flood. Questionnaires were returned within 2 weeks of the mailing, or 6 weeks subsequent to the flood.
Mothers completed two questionnaires at both Time 1 (within 8 weeks prior to flood) and Time 2 (6 weeks subsequent to flood) regarding their preschool child's behavior. The first questionnaire, the Colorado Child Temperament Inventory (CCTI; Rowe & Plomin, 1975) is a 30-item questionnaire that assesses preschoolers' behavior in six areas: sociability, activity level, emotionality, attention span, soothability, and reaction to food. The second questionnaire, the Eyberg Child Behavior Inventory (ECBI; Robinson, Eyberg, & Ross, 1980), is a 36-item questionnaire that assesses the severity of various child behavior problems, including noncompliance, defiance, aggression, crying, seeking attention, distractibility, and bedwetting. Both questionnaires were developed to be used with preschool-aged children, and have been found to have adequate reliability and validity.
At Time 2, mothers also completed a questionnaire regarding the extent to which their family was impacted by the flood. This questionnaire asked the mother to provide information regarding the length of the family's evacuation, the amount of damage sustained in the family's residence, impact of the flood upon employment of family members, and losses sustained by the child due to the flood.
Subjects were paid $15.00 for participating in the study at Time 1 and $20.00 for completing the questionnaires at Time 2.
Subjects' responses to the flood impact questionnaire revealed that 75% of subjects (i.e., eight families) were evacuated from their homes during the flood. During the evacuation, families lived in an average of 2.5 sites (range = 1 - 4). Of those evacuated, one family was evacuated for 9 days, one family was evacuated for 2 weeks, one family was evacuated for 25 days, one family was evacuated for 30 days, and four families had not yet been able to return to their homes 5 weeks subsequent to the flood. Of those not evacuated, two families sheltered other families during the disaster and three lost employment for 2-5 weeks. Forty-two percent of the subjects (i.e., five families) reported full basement flooding in their homes. Of the remaining subjects, two reported no home damage because they lived in second-floor apartments, and four reported no home damages because they were outside of the flooding area. Fifty-eight percent of the subjects indicated that employment of family members was negatively impacted by the flood (e.g., loss of wages, inability to obtain work during the flood). Forty-two percent of the subjects indicated that their preschooler lost possessions (e.g., toys, clothing) as a result of the flood.
Dependent t-tests were conducted to assess differences in preschool children's behavior from Time 1 to Time 2. Analyses conducted with the data obtained from the CCTI revealed that the preschoolers' activity level decreased significantly from Time 1 to Time 2, t (11) = 2.69, p < .021. Analyses of mothers' responses on the ECBI revealed a significant increase in children's crying from Time 1 to Time 2, t (11) = 2.80, p < .017.
Analyses of the data obtained from the CCTI also revealed a trend for increased emotionality from Time 1 to Time 2, t (11) = 1.55, p = .148. Data obtained from the ECBI revealed that there were also trends for increases in children's slowness in getting ready for bed from Time 1 to Time 2, t (11) = 2.00, p = .071, and increases in children's concentration problems from Time 1 to Time 2, t (11) = 1.86, p = .089. Trends were also seen in decreased teasing of other children from Time 1 to Time 2, t (11) = 1.82, p = .096, and decreased problems in getting dressed in the morning from Time 1 to Time 2, t (11) = 1.89, p = .085.
Simple correlational analyses were conducted to assess the relationship between exposure to the flood and changes in children's symptoms from the pre-flood to the post-flood period. Each family was given an exposure score ranging from 1 to 3, with 1 referring to very little exposure, 2 referring to moderate exposure, and 3 referring to major exposure. Two families were given a score of 1. These two families were not evacuated, suffered no flood damage, and did not lose income during the time of the flood. Five families were given a score of 2. Of these families, two were not evacuated, but lost employment for several weeks and took evacuees into their homes. The other three families were evacuated for periods ranging from 9 days to 25 days, but had no damage to their homes. The remaining five families were given a score of 3. Each of these families was evacuated and experienced full basement flooding in their homes. Simple correlational analyses were conducted assessing the relationships between exposure to the flood and changes in the following children's symptoms: activity level, sociability, emotionality, crying, slowness in getting ready for bed, concentration problems, teasing of other children, and quickness in getting dressed in the morning. Analyses revealed no significant relationship between family flood exposure and the extent to which children's symptoms changed from the pre-flood to the post-flood period.
Analyses revealed some changes in preschoolers' behavior post-flood. Specifically, the preschoolers in this sample were significantly more likely to cry after the flood than they were before the flood. There was also a significant change in children's activity level, with children showing a decrease in activity level after the flood. There were trends for children to be less likely to tease other children, more emotional, slower in getting ready for bed, and quicker in getting ready in the morning after the flood than before the flood. There was also a trend for children to show increased concentration problems after the flood as compared to before the flood.
Taken together, these results suggest that the children were generally less active and more emotional after the flood as compared to before the flood. The results regarding children's post-flood reluctance to go to bed and quickness in getting ready in the morning suggest that the preschoolers may also have been more concerned about separation from parents after the flood than they were before the flood. Overall, these results are consistent with the literature describing increased separation anxiety in preschoolers subsequent to disasters (e.g., Blaufarb & Levine, 1972; Ponton et al., 1991; Sullivan et al., 1991).
No significant relationships were found between the family flood exposure and the change in children's symptoms from before the flood to after the flood. These results contradict the results obtained by Burke et al. (1982) and Guerin et al. (1991). Our failure to find a significant relationship between family flood exposure and children's symptoms may be due to the small sample size. Alternatively, it may be that the low variability in children's exposure to the disaster in the present study may have decreased the chance of obtaining a significant correlation between exposure and symptoms. The majority of children in the present study experienced profound exposure to the disaster (e.g., evacuation, damage to home, loss of possessions); exposure to the disaster may have been less uniform in previous studies.
One limitation of this study is its small sample size. Because we chose only to study preschoolers for whom we had pre-flood data, our sample was limited to 12 subjects. On the other hand, the internal validity of this study is higher than that of studies that have examined subjects' symptoms only in the post-disaster period. Another relative strength of this study is that subjects' pre-flood data was obtained within the 2 months prior to the disaster and post-flood data was obtained within 6 weeks subsequent to the disaster. Thus, it is likely that changes in children's behavior seen after the flood were more likely due to the disaster and its sequelae than child maturation.
These data represent preschoolers' immediate and short-term responses to a flooding disaster. As mentioned above, our data generally concur with that of Sullivan et al. (1991), Blaufarb and Levine (1972), and Kalayjian (1994) regarding preschoolers' short-term response to disaster. Burke et al. (1982) provides evidence that preschoolers may respond with more externalizing behaviors (e.g., aggressiveness, conduct problems) several weeks or months subsequent to a disaster. A longitudinal study examining preschoolers' behavior shortly before a disaster, shortly after a disaster, and longer periods of time after a disaster would clearly be advantageous. Such a study could provide information regarding changes in preschoolers' symptoms concurrent with the disaster as well as significant occurrences after the disaster (e.g., return to home, during "clean-up" period, holidays, anniversary of disaster).
In their review of the literature regarding interventions for children following disasters, Vernberg and Vogel (1993) describe four psychological tasks that children face subsequent to disasters. These include 1) accepting the events that have occurred; 2) identifying, labeling, and expressing emotions; 3) regaining a sense of mastery and control; and 4) resuming age-appropriate roles and activities. The literature provides suggestion as to how parents and other caregivers may assist preschoolers and older children in accomplishing these tasks. It is important to point out that no controlled trials of these proposed interventions have been conducted; however, recommendations for intervention are derived from the work of clinicians and researchers who have worked extensively with children who have experienced disasters and other traumatic events.
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The North Dakota Journal of Human Services, October 1998