Child and adolescent mental health is central to the future development any society or country throughout the world. Mental health problems in childhood and adolescence can have far reaching effects on the physical well-being, educational, psychological and social development of individuals. There is an increasing awareness that poor mental health on the part of youth leads to lack of participation in health promotion activities, failure to achieve educationally, lack of ability to participate in work skills development, and adds to the burden in developing societies with increased participation and instigation of violence, abuse of self and others, and support for a broad range of illegal activities. Obviously investing in child mental health is of paramount importance.
It is a common assumption that personal creativity and character are often born out of early tragedy. However, it is not always that creativity and character emerge out of early tragedy. In fact, more often than not, early traumatic life experiences have been seen to have a profound and adverse impact on the emotional, cognitive, behavioral and physiological functioning of an individual for the whole of his life. Disasters, both, natural or human-made are worldwide an all-too-common element of today's life. The behavioral and psychological responses seen in disasters are not random; they frequently have a predictable structure and time course. For most individuals post disaster psychological symptoms are transitory. For some, however, the effects of a disaster linger long after its occurrence, rekindled by new experiences that remind the person of the past traumatic event. Even normal life events can cause anxiety and bring to mind a destroyed home or deceased loved one. Hence, at an individual level, some may experience a disaster or traumatic event with few or no psychological disturbances, while others will go through the same disaster and be emotionally devastated. Beyond individual variations, certain categories of people are especially vulnerable or vulnerable in specific ways. Children and adolescents are at a higher risk of becoming victims and suffering the losses resulting from disasters and traumatic events. Since the young brain is yet to fully develop psychological mechanisms, children and adolescents are more vulnerable to emotional actions and reactions. When they assume they are getting pushed against the wall, they get dominated by their emotions and instinctual emotion based reactions. The recognition of psychological problems in children by adults is important, as it is they who determine whether and where consultation and treatment will be sought. Children are much more vulnerable; the younger they are the more difficult it is for them to understand what has happened. Some do organize, adapt and recover in a surprising manner, despite the traumatic experience they have lived through or witnessed; individual protective factors, as well as parental/social support, may help children to recover, thereby preventing severe psychosocial impairment. Nevertheless, a significant proportion of children and adolescents do exhibit post-disaster sequel and substantial levels of impairment in their daily lives. Recent findings have shown that children's reactions to disasters can be severe and are not merely fleeting and transitory.
One of the pioneering studies conducted by Prof. Mushtaq Margoob to assess the effects of exposure to trauma in children in Kashmir revealed that the most common mode of exposure of the affected children to trauma was by witnessing it (75%). Commonest form of re-experiencing the event was through distressing dreams/nightmares (85.71%). Avoidance of people and places related to the original event was the major avoidance mechanism (85.17%). Most patients had an acute onset of PTSD (92.85%), while most of the cases were diagnosed in the chronic stage (71.43%), indicating a delay in diagnosis and treatment.
Two myths are potential barriers to recognizing children's responses to disaster and must be rejected. First, that children are innately resilient and will recover rapidly, even from severe trauma; and that children, especially young children, are not affected by disaster unless they are disturbed by their parent's responses. Both of these beliefs are false. A wealth of evidence indicates that children experience the effects of disaster doubly. Even very young children are directly affected by experiences of death, destruction, terror, personal physical assault, and by experiencing the absence or powerlessness of their parents. They are also indirectly affected through identification with the effects of the disaster on their parents and other trusted adults (such as teachers) and by their parents' reactions to the disaster.
Another barrier to recognizing children's responses to disaster is the tendency of parents to misinterpret their children's reactions. To parents who are already under stress, a child's withdrawal, regression, or misconduct may be understood as willful and hence they may ignore or deny evidence of their children's distress. The child, in turn, may feel ignored, not validated, not nurtured! This may have long term consequences for the child's development. In the short run, feeling insecure, the child may inhibit expression of his or her own feelings, lest he or she distress and drive away the parents even more.
The types of reactions shown by children to trauma include feeling irritable, alone, and having difficulty talking to their parents. Among pre-school children, anxiety symptoms may appear in generalized form as fears about separation, fears of strangers, fears of "monsters" or animals, or sleep disturbances. Older children may engage in repetitive play in which the child reenacts parts of the disaster or in repeated retelling of the story of the traumatic event. The child may express (openly or subtly) concern about safety and preoccupation with danger. Sleep disturbances, irritability, or aggressive behavior and angry outbursts may appear. As children approach adolescence, their responses become increasingly like adult responses. Greater levels of aggressive behaviors, defiance of parents, delinquency, substance abuse, and risk-taking behaviors may be evident. School performance may decline. Adolescents are prone to bouts of depression and anxiety, while younger children demonstrate regressive behaviors associated with earlier developmental stages. Other effects of trauma can include chronic or impulsive outbursts of anger; suicide attempts; antisocial behavior, including substance abuse; feelings of hopelessness, chronic shame or guilt; academic problems resulting from difficulties in learning and memory; and interpersonal problems.
Efforts to provide effective services and interventions for children and adolescents following a traumatic event , therefore represent an important, but frequently overlooked, mental health need. Most children respond sensibly and appropriately to disaster, especially if they experience the protection, support, and stability of their parents and other trusted adults.
For the adults, although the effects of disaster may be profound and lasting, they take place in an already formed personality. For children, the effects are magnified by the fact that the child's personality is still developing. The child has to construct his or her identity within a framework of the psychological damage done by the disaster or the traumatic event. When the symptoms produced by disaster are not treated or when the disaster is ongoing, either because of the destruction wrought (e.g., by an earthquake) or because the source of trauma is itself chronic (e.g., war or family violence), the consequences are even more grave. The child grows up with fear and anxiety, with the experience of destruction or cruelty or violence, with separations form home and family. Childhood itself, with its normal play, love, and affection, is lost. Longer-term responses of children who have been chronically traumatized may include a defensive desensitization. They seem cold, insensitive, lacking in emotion in daily life. Violence may come to be seen as the norm, legitimate. A sense of a meaningful future is lost.
Huda Mushtaq, Consultant Clinical Psychologist, P.G Deptt of Psychiatry, Govt. Medical College Srinagar at the Institute of Mental Health and Neurosciences-Kashmir.
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