A teacher of developmentally disabled children in a school near the World Trade Center reports: "We were in our second floor classroom when 9/11 happened and we were told to evacuate. Some of the children in the class had difficulty with stairs and some had difficulty with vision. The aide and I divided up the children so that we each were responsible for three. It was tough and scary going for a while, trying to get down the stairs and out of the building. We made it safely, but for the rest of the school year the children kept asking me 'What will we do if that happens again? What if we can't go as fast the next time?'"
Jason, aged 9, attends a special class for children with communication difficulties in a Manhattan school: "I watched the planes crashing into the towers on TV a lot with my brother. Then I didn't know what they meant when they kept talking about illegal immigrants and people being detained. I didn't know what that had to do with anything. My brother didn't know either."
Children with developmental delays or disabilities have limitations due to difficulties in the development of sufficient physical, emotional or intellectual capacities to cope with the demands of their environment. Developmental disabilities may include physical disorders such as cerebral palsy and limited vision, as well as language and speech disorders, mental retardation, and pervasive developmental disorders such as autism. Children with developmental disabilities exhibit different levels of understanding and emotional reactions as well as different learning styles and patterns when dealing with normal events.
The effect of a traumatic event, and the duration of the impact, on all children is often underestimated. A survey conducted by the New York City Board of Education reported that tens of thousands of public school children in New York City experienced chronic nightmares, fear of public places, and other indicators of posttraumatic stress syndrome several months after the World Trade Center attack. In addition to the trauma of the initial disaster, children experienced ongoing anxiety due to the frequent "alerts" as well as the media blitz which frequently showed funerals of firefighters and pictures of destruction taking place throughout the world.
Less has been written about children who have emotional, cognitive or physical limitations that might prevent them from fully understanding the events of a disaster or other trauma in relation to themselves. Being aware of the impact that the disaster can have on developmentally disabled children—their particular reactions and behavioral responses—is critical for both caregivers and professionals.
The everyday factors that are involved in working with disabled children assume even greater significance in times of crisis. They need more time, support, guidance and nurturance to understand and internalize traumatic events. Disabled children's areas of weakness become more vulnerable when the content of the material is threatening. Following are some considerations to keep in mind when helping disabled children through the immediate crisis and future months:
- It is important to understand how the child processes information on both a cognitive and an emotional level. Take into account the child's ability and capacity for understanding information, communicating what is heard, and expressing feelings. Children's reactions are also influenced by their disability: for example, a child with a hearing impairment may not pick up cues and information from an event that involved sounds or language. A visually-impaired child may have difficulty in interpreting facial expressions, be confused by visual images or discussion by others of visual images.
- When providing information it may be necessary to alter language and to repeat facts because of possible cognitive limitations or language comprehension problems. Children may not understand what is happening when adults refer to concepts such as the towers being bombed, rescue efforts, germ warfare, DNA, being "on alert." Tailoring the information to the child's strengths is critical; a child with a language disability may do best with explanations that utilize written materials and pictures; children with limited intellectual abilities will require discussions that are concrete.
- Make sure that the children understand the facts correctly; some children put information together inaccurately and come up with fanciful explanations. When possible, have them write, tell or draw what they know about the event.
- Make sure that the explanations are appropriate to the child's age. Some young children, after watching many replays of the World Trade Center disaster, expressed the fear that many, many planes were crashing into the towers. School-age children rely on their peer group for information and socialization, and it is important that they all have the correct information and don't spread inaccuracies. Children with cognitive or emotional difficulties may be more susceptible to believing false information and rumors.
- Be attuned to changes in manifestations of worry and anxiety. Many children with disabilities provide specific cues - words, images, sounds—that signal that they are concerned about their own safety. Warning signs of distress may be facial expressions, nervous tics, changes in speech patterns, sweating, feeling sick, irritability, and avoidance. Children may have difficulty with the overt expression of concerns, but they may be reflected in behavior, such as withdrawal, refusal to participate in activities, separation problems, or acting-out behaviors.
- Children with emotional and behavioral problems may require additional short or long-term assistance in managing their reactions. Those with previous mental health disorders are at risk for increased problems or for developing additional symptoms related to the trauma. It is important to be prepared for increased reactions, such as anger, withdrawal, and aggression, and help them understand the events and learn effective coping strategies.
- Maintain regular routines and schedules to help reduce anxiety and provide children with a sense that things are gradually returning to normal. Be sure they are aware of detailed procedures to be followed in an emergency, that they know the specific people responsible for them and who to contact. Practicing safety plans can reassure children that things will go smoothly and highlight any unforeseen difficulties with organization or management, such as maneuvering wheelchairs.
- Assure children that their perception that events are scary is valid and that even adults can be frightened. But reassure them that adults are in control and that they will make decisions and take care of the children.
- When children are ready to talk about events, don't avoid discussions, unpleasant as they may be. Avoidance of difficult subjects, particularly about death, transmits the message that a topic is taboo. Silence or avoidance eventually can create more anxiety and confusion.
- Limit children's exposure to continual media and replay of images that can be overwhelming. Watch news reports with them and make sure they are correctly processing the information. Many children with disabilities have experienced trauma previously in their lives, which puts them at risk for recurrence of previous reactions to stress.
- When terrorism is involved, as with 9/11, help children identify ethnic slurs and hateful revenge-laden conversations. One example: Shortly after 9/11, a motorist had an effigy of Osama Bin Laden hanging out of the back of the trunk as if the lid had been closed down on him at his waist. A sign on the back of his trunk said "This is what we will do in the Middle East." Find opportunities in the curriculum to educate students about diversity and difference, and get them involved in multi-sensory ways to understand other cultures and beliefs.
- When a traumatic event occurs, whether it be a devastating hurricane or a terrorist attack, it can leave adults shaken and worried about the future. While adults may not share their deep feelings directly with children, many developmentally disabled children are unusually adept are reading their caregivers' non-verbal messages, especially facial cues. Caregivers need to understand their own feelings about the traumatic event and monitor their responses in order to be as effective as possible. Remember that in an airplane emergency the advice to adults is to "put your oxygen face mask on first and then your child's." The message: You need to be in charge of yourself so that you can be of help to others.
About the Authors
Kathleen Monahan, D.S.W., Associate Professor, Director Family Violence Education and Research Center, School of Social Welfare, State University of New York at Stony Brook.
Abraham Lurie, Ph.D., Professor, School of Social Work, State University of New York at Stony Brook.
Robin F. Goodman, Ph.D. is a clinical psychologist specializing in bereavement issues.