Recovery: After a Biological Attack
A biological attack most likely will not have a clear beginning or ending. New cases of exposure may occur while others are in recovery. The timing will depend upon the extent of the area exposed to the agent, the lethality of the agent, the ease with which the illness spreads, and the availability and effectiveness of treatment. What will linger - beyond the physical results of bioterrorism - will be the psychological impact: the undermining of our national confidence and the continuing fear of another attack. Individuals will feel more helpless to protect loved ones. Children will question whether their parents and teachers can keep them safe.
After an act of terrorism or natural disaster, most families can be expected to recover over time, particularly with the support of family, friends, and organizations. The length of recovery will depend upon how frightening the experience was, whether evacuation from home was necessary, and the extent of the injury or loss. Some families will return to their normal routine fairly quickly, while others will have to contend with ongoing medical issues, the loss of a loved one, or other results of the attack.
Children's functioning will be influenced by how their parents and other caregivers cope during and after the event. Children often turn to adults for information, comfort, and help. Parents and teachers should try to remain calm, answer children's questions honestly, and respond as best they can to requests.
In the days following an act of biological terrorism, continue to monitor yourself and your family. If anyone appears to have persistent fears, sadness, anger, irritability, or acting-out behaviors, seek an evaluation from a mental health professional with expertise in posttraumatic stress.
Children's Reactions
Children react differently, during and after an act of terrorism or other crisis, depending on their age, developmental level, and prior experiences. Some will respond by withdrawing, while others will have angry outbursts. Still others will become agitated or irritable. Parents should attempt to remain sensitive to each child's reactions. The following are typical reactions children might exhibit during any disaster:
- Fear and worry about their safety or the safety of others, including pets
- Fear of separation from family members
- Clinging to parents, siblings, or teachers
- Worry that another attack will come
- Increase in activity level
- Decrease in concentration and attention
- Withdrawal from others
- Angry outbursts or tantrums
- Aggression to parents, siblings, or friends
- Increase in physical complaints, such as headaches and stomachaches
- Change in school performance
- Long-lasting focus on the attack, such as talking repeatedly about it or acting out the event in play
- Changes in sleep patterns
- Changes in appetite
- Lack of interest in usual activities, even playing with friends
- Regressive behaviors, such as baby-talk, bedwetting, or tantrums
- Increase in risky behaviors for teens, such as drinking alcohol, using substances, harming themselves, or engaging in dangerous activities
What You Can Do to Help Your Child
Parents should spend time talking to their children, letting them know that it is okay to ask questions and to share their worries. They should answer questions briefly and honestly and be sure to ask their children for their opinions and ideas. Issues may come up more than once and parents should remain patient and open to answering the same questions again. Although it will be hard finding time to have these conversations, parents can use regular family mealtimes or bedtimes to talk. They can let children know what is happening in the family, at their school, and in the community. For younger children, after talking about the attack, parents might read a favorite story or have a relaxing family activity to help them feel more safe and calm.
To help children's recovery, parents should:
- Be a role model. Try to remain calm, so your child can learn from you how to handle stressful situations.
- Monitor adult conversations. Be aware of what adults are saying about the attack. Children may misinterpret what they hear and be unnecessarily frightened.
- Limit media exposure. Protect your child from graphic images of the attack, including those on television, on the internet, and in the newspaper.
- Reassure children they are safe. You may need to repeat this frequently, even weeks after the attack. Spend extra time with them, playing games outside, reading together indoors, or just cuddling. Be sure to tell them you love them.
- Calm worries about their friends' safety. Reassure your children that their friends' parents are taking care of them, just the way they are being taken care of by you.
- Tell children about community recovery. Reassure children that things are being done to help those who got sick. Tell them that the government is taking steps to make sure people are protected against future attacks.
- Take care of your children's health. Help them get enough rest, exercise, and healthy food. Be sure they have a balance of quiet times and physical activities.
- Maintain regular daily life. Even in the midst of disruption and change, children feel more secure with structure and routine. As much as possible, keep to regular mealtimes and bedtimes.
- Maintain expectations. Stick to your family rules about good behavior and respect for others. Continue family chores, but keep in mind that children may need more reminding than usual.
- Encourage children to help. Children cope better and recover sooner if they feel they are helping out. Give them small clean-up tasks or other ways to contribute. Afterward, provide activities that are not related to the attack, such as playing cards or reading.
- Be extra patient once children have returned to school. They may be more distracted and need extra help with homework for a while.
- Give support at bedtime. Children may be more anxious at times of separation from parents. Spend a little more time talking, cuddling, or reading than usual. (You will want to start the bedtime routine earlier so children get the sleep they need). If younger children need to sleep with you, let them know it is a temporary plan, and that soon they will go back to sleeping in their own beds.
- Keep things hopeful. Even in the most difficult situation, it is important to remain optimistic about the future. Your positive outlook will help your children be able to see good things in the world around them. This will help get them through even the most challenging times.
- Seek professional help if your child still has difficulties more than six weeks after the attack.
Therapy for Children
If children have difficulties for more than six weeks after the attack, consult a mental health professional for an evaluation. If the clinician recommends counseling, keep in mind that Cognitive-Behavioral Therapy (CBT) has the strongest evidence for helping children recover from a disaster. Therapy for children should typically include:
- Family involvement
- Awareness of developmental level and cultural/religious differences
- Assessment of preexisting mental health problems and prior traumas and loss
- Explanation and normalization of the child's psychological reactions to the attack
- Teaching ways to manage reactions to reminders of the attack
- Teaching problem-solving and anger management skills as needed
- Helping to maintain normal developmental progression
What Parents Can Do to Help Themselves
Parents may have a tendency to neglect their own needs during a crisis. In order to be able to take care of their children, parents must take care of themselves. Here are some things parents should keep in mind:
- Take care of yourself physically. Eat healthily, get enough sleep, and get proper medical care.
- Support each other. Parents and other caregivers should take time to talk together and provide support as needed.
- Put off major decisions. Avoid making any unnecessary life-altering decisions during this stressful post-attack period.
What Teachers Can Do to Help Their Students
Teachers can play an important role in helping their students recover. Returning to school is important, in and of itself, in promoting the welfare of children and families. Try the following suggestions to assist you in your work with children, adolescents, and families:
- Take care of yourself emotionally. You and your family may have had a stressful experience and may have suffered losses and stresses like those of your students. To be able to support them, you must have support yourself.
- Take care of yourself physically. Eat healthily, get enough sleep, and get proper medical care.
- Communicate with others. Make sure that you and your fellow teachers schedule ongoing times to talk together and give each other support. Teachers might consider covering for each other, if something comes up that must be taken care of.
- Put off major decisions. Avoid making any unnecessary life-altering decisions during this stressful, post-attack period.
- Put aside the time to take care of the personal needs of your own family. Even though you may be very committed to your students, take special time with your own family members or friends.
- If you have a lot of attack-related responsibilities, talk with your school administrators about temporarily altering your work schedule.
