- Email: [email protected]
World of Trouble (and how children develop in it)
Applied Developmental Psychology 25 (2004) 491 – 500
Book review A World of Trouble (and how children develop in it) Annette M. La Greca, Wendy K. Silverman, Eric M. Vernberg, and Michael C. Roberts (Eds.); Helping children cope with disasters and terrorism, American Psychological Association, Washington, DC, 2002, 446 Pages, ISBN 1-55798-914-1 (cloth) (US$39.95) 1. Introduction Helping Children Cope with Disasters and Terrorism, edited by Annette M. La Greca, Wendy K. Silverman, Eric M. Vernberg, and Michael C. Roberts (published by APA in 2002), is an important book on a disturbing topic. It reviews research and interventions for children and adolescents who have experienced some of the worst events in our world, from storms and wildfires to horrendous acts of violence such as hostage taking, terrorism, and war. While it is not primarily a developmental book, the research in it raises some interesting developmental questions. This review will consider the importance of this research to developmental psychologists and the ways in which a more developmental approach to disaster research (advocated by the book’s editors) might contribute to our understanding of the effects of such terrible events on children. La Greca and colleagues, all clinical psychologists, have not only assembled an impressive group of chapter authors, but have also provided a useful conceptual structure in four sections to guide the understanding of psychologists in other fields. The first section provides an introduction to key concepts in the literature: definitions, assessment and intervention approaches, and multicultural issues in the responses of children to disasters. The next three sections describe disaster research of three kinds: natural disasters such as floods and hurricanes, human-caused and technological disasters such as toxic waste spills and motor vehicle accidents, and violent disasters such as war, terrorism, and community violence. Most chapters offer cogent reviews of the literature on the disaster in question, and some also describe intervention approaches in detail. All describe the current methodological and assessment issues unique to studying how children are affected by disasters. Such effects are not easy to study. Most disasters happen without warning, and in the aftermath, survival takes priority over data collection. Later, people may be protective of their children, or simply too traumatized to be willing participants in research. Another difficulty is that many assessment measures used for studying disaster victims were designed for adults and must be adapted for children. Despite these limitations, a large body of literature has been amassed, enough for us to see some common findings about children, whether the disaster is a wildfire or a war. Among those, the following seem to me to be the most important for developmental psychologists: (A) Disasters of all three types are harmful to children’s mental health and may cause long-term developmental disturbances. While this may seem ridiculously obvious, it, in fact, contradicts a doi:10.1016/j.appdev.2004.06.006
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long-held opinion in the field that children, due to their youth, are more resilient and less traumatized by disasters than adults are. In this collection of 12 chapters on different kinds of disasters, no chapter reports evidence that children are unaffected by disasters or survive them easily. As a researcher in a different field, it seemed absurd to me, at first, that we even need to report ‘‘evidence’’ for this kind of harm, since it should be obvious that having your house blown up or losing your parents in a war are bad experiences for children. But reading this book clarifies the importance of this evidence for everyone who works with children, especially those who make policies related to disaster relief. Specific events call for specific interventions, thus, it matters that we know just what kind of harm disasters cause to children’s development. The evidence also shows that the resilience notion is wrong and potentially harmful if it discourages postdisaster help for children. (B) In most disasters, the amount of exposure that an individual child experiences is related to the amount of trauma to the child, but even minimal exposure can be harmful. In Chapter 5 (‘‘Hurricanes and earthquakes’’), Annette La Greca and Mitchell Prinstein note that children from neighborhoods severely affected by a disaster (e.g., close to an earthquake epicenter or the eye of a hurricane) experience more severe and prolonged symptoms of posttraumatic stress disorder (PTSD) than do children from less severely affected neighborhoods. But children do not have to be the most exposed victims of disaster to be affected negatively. Even moderate levels of exposure can result in trauma symptoms for some children. (C) Children watch a lot of disaster-related television, and it does not help them. In the aftermath of the Oklahoma City bombing, Pfefferbaum et al. (2001) observed that most of the children that they sampled reported that ‘‘most’’ or ‘‘all’’ of their television viewing was bomb related, and television watching correlated with posttraumatic stress symptoms both for children who had direct exposure to the bombing and in children who had no physical or interpersonal exposure (reported in Chapter 14, ‘‘The aftermath of terrorism,’’ by R. H. Gurwitch, K. A. Sitterle, B. H. Young, and B. Pfefferbaum). Television watching was a stronger predictor of posttraumatic stress symptoms than either physical or interpersonal exposure was for middle school students. Although these findings are no surprise to anyone familiar with research on the effects of television, they should bolster the arguments made by child psychologists against exposing children, especially young ones, to disaster-related media. In the aftermath of September 11, 2001, much comment was made about children who repeatedly saw the airplane crash into the World Trade Center on television and thought the event itself was happening over and over. Television stations were urged to stop showing this image, but a more appropriate response would have been to urge parents not to let their young children watch it. (D) Children are not all affected in the same way by disasters. In Chapter 1 (‘‘Children experiencing disasters: Definitions, reactions, and predictors of outcomes’’), Silverman and La Greca show that age, gender, ethnicity, race, and cultural background all may affect children’s ability to cope with disasters, but these effects are not yet well understood. Many studies, for example, report gender differences in PTSD symptoms after disasters, with girls showing more symptoms than boys do. Minority youth report more PTSD symptoms than nonminority youth do. Children with preexisting mental health or academic achievement problems have more difficulty during disasters than do children without these problems. Results are mixed, however, and researchers are not in agreement about the meaning of these findings. The fact that children who already have problems have a harder time with disasters than children who do not is hardly surprising, but gender and ethnic differences in trauma symptoms could be interpreted in many ways. Do girls really experience more trauma
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symptoms than boys do, or are they just more willing to acknowledge their feelings? Are race and ethnicity really markers for other variables, such as socioeconomic resources, stress from discrimination, or cultural beliefs? Developmental research related to gender and cultural differences in the general population could be a useful source of interpretation for psychologists studying these differences in disaster victims, especially because, as these authors correctly point out, limited attention has been paid to multicultural issues in disaster research. (E) Parents consistently underestimate and underreport the amount of psychological distress that their children have experienced during disasters. This phenomenon is so commonly observed that it should be the focus of detailed study in its own right. It is reported in a number of chapters, including those of Nader and Mello (Chapter 13, ‘‘Shootings, hostage takings, and children’’) and of Gurwitch, Sitterle, Young, and Pfefferbaum (Chapter 14, ‘‘The aftermath of terrorism’’). Often, there is a large difference in the amount of distress reported by parents and that observed by researchers or service providers. In Chapter 10 (‘‘Mass transportation disasters’’), Yule, Udwin, and Bolton note that there has long been a presumption that children are so resilient that the category of PTSD is not needed to describe their postdisaster experiences. They argue, as do other authors in this book, that this presumption is based on early studies that relied on adult reports and did not actually interview children. In their own studies, Yule and colleagues found a high level of distress in children who survived a shipping disaster when clinical interviews and self-completion measures were used (Yule, ten Bruggencatte, & Joseph, 1994; Yule & Udwin, 1991). Similarly, Gurwitch and Pfefferbaum (1999) evaluated mothers and children at the YMCA day care center adjacent to the site of the Oklahoma City bombing and found that although mothers reported few symptoms of PTSD in their children, the mental health team treating the children observed many signs of it (reported in Chapter 14, ‘‘The aftermath of terrorism’’). Why do parents, who presumably know their children better than researchers, so consistently underreport their children’s distress after a disaster? Various possible explanations have been offered; in Chapter 6 (‘‘Wilderness area and wildfire disasters: Insights from a child and adolescent screening program’’), McDermott and Palmer observed that children often are reluctant to burden their parents with their distress, or may have difficulty talking to their parents during a trauma. In addition, Gurwitch and Pfefferbaum (1999) noted that the mothers in their study endorsed many symptoms of PTSD for themselves, even as they reported few in their children. It is possible that traumatized adults are not able to judge accurately how traumatized their children are, and in most of this research, the disaster in question has been experienced by both parents and their children. Whatever the reason, this phenomenon has important implications for the treatment of families after disasters because children might not receive needed help if their parents are unable to see their distress. The above findings and many others are all important, but most of the authors in this collection express frustration with how much remains unknown and difficult to study. Part of the problem seems to be the clinical models used in disaster research, which are sometimes limited in focus. An example is the concept of coping, a fairly short-term process, which, in this context, seems to mean how people get back to normal or how they function despite a crisis event. This is, of course, the priority for clinicians who help people in the aftermath of these terrible events. But the difficulties in following disaster victims for long periods of time mean that many long-term effects on children have not been studied.
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Another limitation to the construct of coping is that it is very much related to identifying a specific set of symptoms and then tracking the severity of those symptoms over time. The most commonly studied seem to be PTSD, poor functioning in school, anxiety, and depression. If these symptoms abate, children are said to be coping well; if they do not, children are not coping and may need more intervention. The underlying assumption behind helping children ‘‘cope’’ seems to be that if we can minimize the trauma that they experience, the basic developmental mechanisms will resume quickly, and functioning will return to normal. But the only way to see if this really happens is to do much more long-term follow-up than is currently done and to study variables that are not usually studied. Frustration with this state of affairs is expressed by many of the chapter authors and by the book’s coeditors. Current models simply do not go far enough in explaining how children deal with disasters. For developmental psychologists, it is not enough to know whether children ultimately ‘‘recover’’ from a disaster so that they have fewer symptoms of trauma and are functioning well (going to school, having friends, etc.). Children, no matter what their previous level of pathology or particular level of exposure to a disaster, are all in a state of change because they are still developing. Because children are likely to be working on particular developmental issues in certain age ranges, any assessment or intervention that is used with them will be interacting with developmental variables. If these variables are not addressed in trauma assessments, an incomplete picture will result. Basic survival and relief of symptoms may need to come first, but we also need to know how children’s experiences have altered the way they see the world: their concepts of self, for example, or their moral reasoning. Future research should be looking not only at how children survive disasters, but what kind of people they develop into following such experiences. In considering how this could be done, we need to look at what is developmental about the current research, and what is not, but could be.
2. What is developmental about disaster research? Since disaster researchers tend to come from a clinical background, it is no surprise that their work is not primarily developmental in focus. But most of the authors in this collection recognize the need for redesigning assessment instruments used with adults so that children can understand them and for developing new instruments specifically for children. Several chapters describe intervention approaches that use materials designed to be developmentally appropriate (Chapter 5, ‘‘Hurricanes and earthquakes’’; Chapter 6, ‘‘Wilderness area and wildfire disasters’’). Some studies have attempted, when possible, to contrast the effects of disasters on children of different ages. How do young children, for example, handle the stress of a flood or hurricane compared with older children or adolescents? This kind of work has the same problem that cross-sectional studies always have, namely, that age differences do not necessarily reflect age-related changes. Longitudinal studies are needed to clarify the relationship between age and time, but aside from a few follow-up studies in the years after disasters, this has not been a major focus. Most follow-up studies have not covered more than a few years and have made no attempt to bridge significant age levels, such as the transition from middle childhood into adolescence. In Chapter 11 (‘‘Dam break: Long-term follow-up of children exposed to the Buffalo Creek disaster’’), Korol, Kramer, Grace, and Green reported a follow-up 17 years after a disaster, but with such a long interval between contacts with the participants, it was difficult to draw any real developmental conclusions from the results.
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Even when age differences are observed in disaster studies, it is hard to know what they might mean. When developmental psychologists do cross-sectional studies, they look at variables that are presumed, based on developmental theory, to have been changing throughout the years in response to normal life activities and physical maturation. But similar developmental trajectories cannot be presumed for postdisaster symptoms, and it is unknown how such symptoms interact with age. At present, we lack a developmental theory of disaster response; thus, cross-sectional studies are limited in what they can tell us. Of course, they should also use different variables. The models used in disaster studies are very symptom based, with PTSD symptoms the most commonly explored. This approach is not developmental—symptoms may be present to a greater or lesser degree, but there is no presumed interaction with time or with biological changes that are normative. Only Chapter 12 (‘‘The traumatic impact of motor vehicle accidents’’ by J. R. Scotti, K. J. Ruggiero, and A. E. Rabalais) actually outlines a theoretical model. Although labeled a ‘‘paradigmatic model of accident-related PTSD,’’ it includes more developmental elements than most of the other chapters do. Among them are ways to approach psychopathology developmentally by identifying (a) deviations from age-appropriate norms, (b) exaggerations of typical development, and (c) behaviors that are pathological because they interfere with typical development. Memory of traumatic events is important and, therefore, so is memory development in children. Emotional, language, cognitive, and sensory-motor development all matter because of their effects on the expression of PTSD symptoms, but genetically based characteristics and biological differences are also stressed. Finally, the child’s learning history prior to the event interacts with learning about the event to produce different outcomes. Many elements of this model could be used to examine children’s responses to other disasters, and the model itself could be expanded to look at more than PTSD symptoms. A final observation is that the chapters on violent disasters seem to take a more developmental approach than the others do. In Chapter 13 (‘‘Shootings, hostage takings, and children’’), Nader and Mello discuss the interaction of adolescence as a period of turmoil and disequilibrium with social environmental forces that include violent media images and the accessibility of weapons. They note that details of traumatic events become embedded in aspects of life following the event and may have negative effects on trust, moral development, and sense of ongoing safety. Similar effects are described in Chapter 14 (‘‘The aftermath of terrorism’’), as well as the effects of television discussed earlier. In Chapter 15 (‘‘Children under stress of war’’), Avigdor Klingman reports that this experience, at adolescence, has a long-lasting effect on survivors’ adult lives. Sociopolitical influences on identity are particularly powerful, and political ideology and commitments may buffer the experience of war. Several developmental assessment approaches are also discussed. Finally, Chapter 16 (‘‘Children’s exposure to community violence’’ by J. Kupersmidt, A. Shahinfar, and M. E. Voegler-Lee) cites evidence that exposure to community violence affects both moral development and the development of maladaptive social information-processing patterns.
3. What, according to the editors, should be more developmental about disaster research? In the final chapter of the book, the four editors offer their recommendations for future directions for research and public policy. A number of these involve taking a more developmental look at children’s responses to disasters, and the editors acknowledge, as a major obstacle, the absence of theories and models for directing research and intervention efforts. They propose moving beyond the symptoms of
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PTSD to the ‘‘larger issue,’’ which is to understand how exposure to disasters at various points in the developmental period affects developmental trajectories in multiple domains, including biological, cognitive, behavioral, and interpersonal functioning. The disaster research field, they argue, needs to move beyond asking what factors predict outcomes and begin to ask why certain variables are important, by what processes certain variables influence children’s reactions, and how those processes vary as a function of children’s development. The editors acknowledge that this task may require new ways of thinking to adapt existing theories to explain children’s reactions to disaster or to develop new theories that are specific to children and disasters. They note that children’s developmental level is an important moderating variable that has not been addressed in most conceptual models of children’s disaster reactions. They offer several examples of relevant variables that change with age, such as the ability to accurately interpret the degree of threat posed by events, threshold and tolerance for arousal, inhibition of the startle reflex, and the ability to attend to multiple dimensions of experience. These are all important and, to a developmental psychologist, exciting recommendations. However, much more could be done, I would argue that an important ‘‘new way of thinking’’ would be to apply both developmental methods and theories to disaster studies.
4. How should developmental methods be used in disaster studies? Developmental questions need to be answered with developmental methods. The disadvantage of not doing this is illustrated in Chapter 10 (‘‘Mass transportation disasters’’) by Yule, Udwin, and Bolton. They describe an event in which a cruise ship with 400 British teenagers aboard was struck by another ship. Most of the students survived, but the dangerous rescue effort involved several deaths and was very traumatic for the survivors. In a 5- to 7-year follow-up study, the authors stated that they wanted to see how the adolescents who experienced this shipping disaster were later negotiating changes into adulthood, especially in the areas of work and intimate relations. But what they assessed in their follow-up study were mental health risk factors, such as PTSD, anxiety disorders, phobias, panic disorders, and depression. No developmental issues, such as identity or intimacy statuses, were studied. The presence or absence of clinical symptoms cannot answer the developmental questions that these researchers were asking, but developmental research methods could. Follow-up studies, especially of this duration, should look at all aspects of development, not just trauma-related symptoms. This is true for at least two reasons: (1) To really understand the effects of disasters on children, we need to see how these experiences have been integrated with all aspects of their development, including (at minimum) cognition, sense of self, identity, moral reasoning, social understanding, and perspective taking. Otherwise, we have no way of knowing, as the coeditors suggest we should know, ‘‘how exposure to disasters at various points in the developmental period affects developmental trajectories in multiple domains.’’ (2) Assessing children’s normal development, as well as their trauma symptoms, would tell us more than we can currently know about recovery from a disaster; at present, we mostly know whether they demonstrate trauma symptoms, but not much else. Of course, systematically following the same individuals over time would be better than collecting group data at an arbitrary point in time after a disaster, which seems to have been the case in some studies. And although several studies in this book reported efforts to document different effects of disasters on children of different ages, none
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were able to follow those children longitudinally to see how they resolved developmental issues as they matured. One of the reasons why this would be interesting is that some of these studies found the immediate or short-term effects of trauma to be less for younger than for older children. But without longitudinal work, we cannot know if this continued to be true, or if there were ‘‘sleeper’’ effects on younger children as they moved into different developmental phases. Among children who had no risk factors before the disaster, older children would have more years of normal development behind them than younger children do, and although their initial symptoms might look worse, their eventual integration of the experience might be better due to their more advanced development. Another use for longitudinal studies would be in contrasting the effects of different kind of disasters on children. Almost all disaster studies look for the same symptoms (PTSD, anxiety, and depression) and usually find them. But do children really experience natural disasters, such as floods or hurricanes, in the same way they experience wars, hostage takings, or neighborhood shootings? This seems very important to investigate because terrible events caused by nature are different in many ways from acts of violence. It is one thing for children to learn that no one is safe from some forces of nature; it is quite another to be faced early in life with the many ways in which humans are not safe from each other. Longitudinal developmental studies that look at how the particular event becomes a part of children’s ongoing understanding of the world might show us whether the trauma of violence had a different long-term effect on the developing personality than the trauma of natural disasters had. A more developmental approach also could be taken with the construct of PTSD, around which much of the research literature in this area revolves. Most studies have found that children and adolescents report high levels of PTSD following disasters. For a person to be identified as experiencing PTSD, three symptom clusters must be met: reexperiencing (recurrent thoughts about the event; intense stress at reminders of the event), avoidance or numbness (avoiding feelings or reminders of the event, detachment or removal from others, diminished interest in normal activities), and hyperarousal (difficulty sleeping, hypervigilance, angry outbursts, exaggerated startle response). These important symptoms should not, as Silverman and La Greca point out in Chapter 1, be the only thing we study about children, and they note that anxiety and depressive disorders have also been observed. But what is most interesting from a developmental perspective is Silverman and La Greca’s point that it is not very clear from existing research the extent to which these symptoms ‘‘interfere with children’s day-to-day functioning and thus may be pathological, or, alternatively, whether the symptoms might be considered to be normal reactions to abnormal events.’’ How do we decide what is pathological about children’s responses to catastrophic events? Interference with day-to-day functioning seems a very minimal criterion for calling something pathological. What really is normal functioning? Is it normal to go to school, play with your friends, and act as if nothing has happened, when indeed, something unthinkable has? Theories of development might provide a deeper way of looking at how children process disasters and integrate such events with their larger understanding of their world.
5. How should developmental theories be used in disaster studies? What is mostly missing in this literature is a connection with any particular developmental theory. Some studies show how crises interrupt or disrupt age-appropriate activities, but they do not use
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developmental theories to explore how the crisis experience is ultimately integrated into the life course development of the individual. As children recover from disasters, are they the same people they were before, or are they different in some ways that will always be with them? Some developmental theories seem particularly relevant to certain disasters, although they have been largely untapped by researchers. For example, cognitive development is mainly discussed in terms of limitations on children’s ability to understand key concepts relating to why disasters happen or what they mean, or to understand assessment instruments originally designed for adults. But aside from consideration of children’s cognitive limits, there is little study of the relation between cognitive development and particular disasters. How well do children understand natural disasters and what causes them? Studies of natural disasters should take into account what children actually know about natural phenomena. The intuitive theory approach used in many developmental studies (e.g., Carey, 1985, 1991; Keil, 1989, 1992) focuses on children’s developing theories of the biological and physical world. It could offer a useful framework for exploring children’s comprehension of natural disasters. Cognitive variables are relevant to toxic waste disasters as well. This is one area where studies have found children’s distress to be significantly less than that of adults, probably because children do not understand that they may be at risk for future birth defects in their own children from their present exposure to toxic waste (Chapter 9, ‘‘Toxic waste spills and nuclear accidents,’’ by M. C. Wroble and A. Baum). Comprehending the risk of future birth defects and the role of toxic waste exposure in creating that risk probably requires both specific information about genetics and advanced cognitive development. But if only distress is measured and not understanding, the relation between cognition and distress cannot be established. This relationship, while alluded to in several studies, is not really explored, because the studies typically do not assess children’s and adolescents’ actual understanding of disasters. Whether they experience natural disasters or political upheavals, children’s understanding of the world is very likely to affect their reactions, but we cannot demonstrate that if we only study their reactions and not their understanding. Other disasters relate to other developmental theories, offering a number of possibilities to be explored. Studies of hostage taking and terrorism could look at the effects of these experiences on the development of perspective taking, using the work of Selman (1976). Studies of children growing up in war zones, where people who look very much like them are nevertheless identified as their enemies, may find developmental research on identity by Erikson (1963) and contemporary researchers (Marcia, Waterman, Matteson, Archer, & Orlofsky, 1993) to be helpful. Finally, many studies of children’s reactions to disaster could be usefully informed by research in the development of event and autobiographical memory (Nelson, 1996), especially memory for unusual and noteworthy events (Hammond & Fivush, 1991). Using developmental theories could give us a broader understanding of the lifelong effects of disaster on children, but developmental theories should also expand to account for the effects of disasters. Most theories of human development assume certain ‘‘normative’’ life experiences for children, and while disasters are not normative, they are, unfortunately, too common to be ignored.
6. Conclusion This book, published in 2002, does not include research related to the events of September 11, 2001. Much research about those events has begun, as evidenced by the many presentations at the
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2003 meetings of the Society for Research in Child Development. More researchers are studying international terrorism and its effects on children, and this volume is very informative to that work, especially the chapters on hostage taking, war, and the aftermath of terrorism. But the current climate of global threat also calls for a more developmental approach because all children are affected, at least indirectly, and more children are experiencing violence as an ongoing part of life rather than a one-time event. Thus, we should be studying not just the immediate effects of particular events, but how the whole concept of terrorism affects children’s understanding of their world. La Greca, Silverman, Vernberg, and Roberts, along with the individual chapter authors, have done a superb job with the important but surely unpleasant task of describing just how bad things can get in this world and just how seriously those things can affect the development of our young people. Even with their dispassionate style of presentation, the evidence is harrowing, particularly in the chapters on violence. It is important for developmental psychologists to think about integrating this material with our theories of human development. Natural disasters will always be a part of life on this planet. But as we typically describe it, normative development does not (and should not) include learning how to behave in a hostage situation, protecting yourself from sniper fire, watching your friends and family get shot, seeing bloody, mutilated bodies, and dealing with death threats from gang members. As knowledge of these horrors become more widespread, we should share with our clinical colleagues the task of documenting the evidence that development cannot progress normally under these conditions. Annette La Greca and her colleagues offer many recommendations to governments and policymakers for handling disasters of all kinds. But none is more powerful than the book in its entirety, which offers a thorough and comprehensive message that all of our children deserve a better world than this.
References Carey, S. (1985). Conceptual changes in childhood. Cambridge, MA: Bradford/MIT Press. Carey, S. (1991). Knowledge acquisition: Enrichment or conceptual change? In S. Carey, & R. Gelman (Eds.), The epigenesis of mind: Essays on biology and cognition ( pp. 257 – 291). Hillsdale, NJ: Lawrence Erlbaum Associates. Erikson, E. H. (1963). Childhood and society (2nd ed.). New York: Norton. Gurwitch, R. H., & Pfefferbaum, B. (1999, February). Children and trauma: Lessons from the Oklahoma City bombing. Paper presented at the Rocky Mountain Region Disaster Mental Health Conference, Laramie, WY. Hammond, N. R., & Fivush, R. (1991). Memories of Mickey Mouse: Young children recount their trip to Disney world. Cognitive Development, 6, 433 – 438. Keil, F. C. (1989). Concepts, kinds, and cognitive development. Cambridge, MA: MIT Press. Keil, F. C. (1992). The origins of autonomous biology. In M. R. Gunnar, & M. Maratsos (Eds.), Modularity and constraints in language and cognition. Minnesota symposia on child psychology (Vol. 25, pp. 103 – 137). Hillsdale, NJ: Lawrence Erlbaum Associates. Marcia, J. E., Waterman, A. S., Matteson, D. R., Archer, S. L., & Orlofsky, J. L. (Eds.). (1993). Ego identity: A handbook for psychosocial research. New York: Springer-Verlag. Nelson, K. (1996). Language in cognitive development: The emergence of the mediated mind. New York: Cambridge University Press. Pfefferbaum, B., Nixon, S., Tivis, R., Doughty, D., Pynoos, R., Gurwitch, R. H., & Foy, D. (2001). Television exposure in children after a terrorist incident. Psychiatry, 64, 202 – 211. Selman, R. L. (1976). Social-cognitive understanding: A guide to educational and clinical practice. In T. Lickona (Ed.), Moral development and behavior: Theory, research, and social issues (pp. 299 – 316). New York: Holt, Rinehart, and Winston.
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Yule, W., ten Bruggencatte, S., & Joseph, S. (1994). Principal components analysis of the impact of events scale in children who survived a shipping disaster. Personality and Individual Differences, 16, 685 – 691. Yule, W., & Udwin, O. (1991). Screening child survivors for post-traumatic stress disorders: Experiences from the ‘‘Jupiter’’ sinking. British Journal of Clinical Psychology, 30, 1051 – 1061.
Bridget A. Franks Department of Educational Psychology, University of Florida, 1403 Norman Hall, P.O. Box 117047, Gainesville, FL 32611, USA E-mail address: [email protected]
Book review A World of Trouble (and how children develop in it) Annette M. La Greca, Wendy K. Silverman, Eric M. Vernberg, and Michael C. Roberts (Eds.); Helping children cope with disasters and terrorism, American Psychological Association, Washington, DC, 2002, 446 Pages, ISBN 1-55798-914-1 (cloth) (US$39.95) 1. Introduction Helping Children Cope with Disasters and Terrorism, edited by Annette M. La Greca, Wendy K. Silverman, Eric M. Vernberg, and Michael C. Roberts (published by APA in 2002), is an important book on a disturbing topic. It reviews research and interventions for children and adolescents who have experienced some of the worst events in our world, from storms and wildfires to horrendous acts of violence such as hostage taking, terrorism, and war. While it is not primarily a developmental book, the research in it raises some interesting developmental questions. This review will consider the importance of this research to developmental psychologists and the ways in which a more developmental approach to disaster research (advocated by the book’s editors) might contribute to our understanding of the effects of such terrible events on children. La Greca and colleagues, all clinical psychologists, have not only assembled an impressive group of chapter authors, but have also provided a useful conceptual structure in four sections to guide the understanding of psychologists in other fields. The first section provides an introduction to key concepts in the literature: definitions, assessment and intervention approaches, and multicultural issues in the responses of children to disasters. The next three sections describe disaster research of three kinds: natural disasters such as floods and hurricanes, human-caused and technological disasters such as toxic waste spills and motor vehicle accidents, and violent disasters such as war, terrorism, and community violence. Most chapters offer cogent reviews of the literature on the disaster in question, and some also describe intervention approaches in detail. All describe the current methodological and assessment issues unique to studying how children are affected by disasters. Such effects are not easy to study. Most disasters happen without warning, and in the aftermath, survival takes priority over data collection. Later, people may be protective of their children, or simply too traumatized to be willing participants in research. Another difficulty is that many assessment measures used for studying disaster victims were designed for adults and must be adapted for children. Despite these limitations, a large body of literature has been amassed, enough for us to see some common findings about children, whether the disaster is a wildfire or a war. Among those, the following seem to me to be the most important for developmental psychologists: (A) Disasters of all three types are harmful to children’s mental health and may cause long-term developmental disturbances. While this may seem ridiculously obvious, it, in fact, contradicts a doi:10.1016/j.appdev.2004.06.006
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long-held opinion in the field that children, due to their youth, are more resilient and less traumatized by disasters than adults are. In this collection of 12 chapters on different kinds of disasters, no chapter reports evidence that children are unaffected by disasters or survive them easily. As a researcher in a different field, it seemed absurd to me, at first, that we even need to report ‘‘evidence’’ for this kind of harm, since it should be obvious that having your house blown up or losing your parents in a war are bad experiences for children. But reading this book clarifies the importance of this evidence for everyone who works with children, especially those who make policies related to disaster relief. Specific events call for specific interventions, thus, it matters that we know just what kind of harm disasters cause to children’s development. The evidence also shows that the resilience notion is wrong and potentially harmful if it discourages postdisaster help for children. (B) In most disasters, the amount of exposure that an individual child experiences is related to the amount of trauma to the child, but even minimal exposure can be harmful. In Chapter 5 (‘‘Hurricanes and earthquakes’’), Annette La Greca and Mitchell Prinstein note that children from neighborhoods severely affected by a disaster (e.g., close to an earthquake epicenter or the eye of a hurricane) experience more severe and prolonged symptoms of posttraumatic stress disorder (PTSD) than do children from less severely affected neighborhoods. But children do not have to be the most exposed victims of disaster to be affected negatively. Even moderate levels of exposure can result in trauma symptoms for some children. (C) Children watch a lot of disaster-related television, and it does not help them. In the aftermath of the Oklahoma City bombing, Pfefferbaum et al. (2001) observed that most of the children that they sampled reported that ‘‘most’’ or ‘‘all’’ of their television viewing was bomb related, and television watching correlated with posttraumatic stress symptoms both for children who had direct exposure to the bombing and in children who had no physical or interpersonal exposure (reported in Chapter 14, ‘‘The aftermath of terrorism,’’ by R. H. Gurwitch, K. A. Sitterle, B. H. Young, and B. Pfefferbaum). Television watching was a stronger predictor of posttraumatic stress symptoms than either physical or interpersonal exposure was for middle school students. Although these findings are no surprise to anyone familiar with research on the effects of television, they should bolster the arguments made by child psychologists against exposing children, especially young ones, to disaster-related media. In the aftermath of September 11, 2001, much comment was made about children who repeatedly saw the airplane crash into the World Trade Center on television and thought the event itself was happening over and over. Television stations were urged to stop showing this image, but a more appropriate response would have been to urge parents not to let their young children watch it. (D) Children are not all affected in the same way by disasters. In Chapter 1 (‘‘Children experiencing disasters: Definitions, reactions, and predictors of outcomes’’), Silverman and La Greca show that age, gender, ethnicity, race, and cultural background all may affect children’s ability to cope with disasters, but these effects are not yet well understood. Many studies, for example, report gender differences in PTSD symptoms after disasters, with girls showing more symptoms than boys do. Minority youth report more PTSD symptoms than nonminority youth do. Children with preexisting mental health or academic achievement problems have more difficulty during disasters than do children without these problems. Results are mixed, however, and researchers are not in agreement about the meaning of these findings. The fact that children who already have problems have a harder time with disasters than children who do not is hardly surprising, but gender and ethnic differences in trauma symptoms could be interpreted in many ways. Do girls really experience more trauma
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symptoms than boys do, or are they just more willing to acknowledge their feelings? Are race and ethnicity really markers for other variables, such as socioeconomic resources, stress from discrimination, or cultural beliefs? Developmental research related to gender and cultural differences in the general population could be a useful source of interpretation for psychologists studying these differences in disaster victims, especially because, as these authors correctly point out, limited attention has been paid to multicultural issues in disaster research. (E) Parents consistently underestimate and underreport the amount of psychological distress that their children have experienced during disasters. This phenomenon is so commonly observed that it should be the focus of detailed study in its own right. It is reported in a number of chapters, including those of Nader and Mello (Chapter 13, ‘‘Shootings, hostage takings, and children’’) and of Gurwitch, Sitterle, Young, and Pfefferbaum (Chapter 14, ‘‘The aftermath of terrorism’’). Often, there is a large difference in the amount of distress reported by parents and that observed by researchers or service providers. In Chapter 10 (‘‘Mass transportation disasters’’), Yule, Udwin, and Bolton note that there has long been a presumption that children are so resilient that the category of PTSD is not needed to describe their postdisaster experiences. They argue, as do other authors in this book, that this presumption is based on early studies that relied on adult reports and did not actually interview children. In their own studies, Yule and colleagues found a high level of distress in children who survived a shipping disaster when clinical interviews and self-completion measures were used (Yule, ten Bruggencatte, & Joseph, 1994; Yule & Udwin, 1991). Similarly, Gurwitch and Pfefferbaum (1999) evaluated mothers and children at the YMCA day care center adjacent to the site of the Oklahoma City bombing and found that although mothers reported few symptoms of PTSD in their children, the mental health team treating the children observed many signs of it (reported in Chapter 14, ‘‘The aftermath of terrorism’’). Why do parents, who presumably know their children better than researchers, so consistently underreport their children’s distress after a disaster? Various possible explanations have been offered; in Chapter 6 (‘‘Wilderness area and wildfire disasters: Insights from a child and adolescent screening program’’), McDermott and Palmer observed that children often are reluctant to burden their parents with their distress, or may have difficulty talking to their parents during a trauma. In addition, Gurwitch and Pfefferbaum (1999) noted that the mothers in their study endorsed many symptoms of PTSD for themselves, even as they reported few in their children. It is possible that traumatized adults are not able to judge accurately how traumatized their children are, and in most of this research, the disaster in question has been experienced by both parents and their children. Whatever the reason, this phenomenon has important implications for the treatment of families after disasters because children might not receive needed help if their parents are unable to see their distress. The above findings and many others are all important, but most of the authors in this collection express frustration with how much remains unknown and difficult to study. Part of the problem seems to be the clinical models used in disaster research, which are sometimes limited in focus. An example is the concept of coping, a fairly short-term process, which, in this context, seems to mean how people get back to normal or how they function despite a crisis event. This is, of course, the priority for clinicians who help people in the aftermath of these terrible events. But the difficulties in following disaster victims for long periods of time mean that many long-term effects on children have not been studied.
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Another limitation to the construct of coping is that it is very much related to identifying a specific set of symptoms and then tracking the severity of those symptoms over time. The most commonly studied seem to be PTSD, poor functioning in school, anxiety, and depression. If these symptoms abate, children are said to be coping well; if they do not, children are not coping and may need more intervention. The underlying assumption behind helping children ‘‘cope’’ seems to be that if we can minimize the trauma that they experience, the basic developmental mechanisms will resume quickly, and functioning will return to normal. But the only way to see if this really happens is to do much more long-term follow-up than is currently done and to study variables that are not usually studied. Frustration with this state of affairs is expressed by many of the chapter authors and by the book’s coeditors. Current models simply do not go far enough in explaining how children deal with disasters. For developmental psychologists, it is not enough to know whether children ultimately ‘‘recover’’ from a disaster so that they have fewer symptoms of trauma and are functioning well (going to school, having friends, etc.). Children, no matter what their previous level of pathology or particular level of exposure to a disaster, are all in a state of change because they are still developing. Because children are likely to be working on particular developmental issues in certain age ranges, any assessment or intervention that is used with them will be interacting with developmental variables. If these variables are not addressed in trauma assessments, an incomplete picture will result. Basic survival and relief of symptoms may need to come first, but we also need to know how children’s experiences have altered the way they see the world: their concepts of self, for example, or their moral reasoning. Future research should be looking not only at how children survive disasters, but what kind of people they develop into following such experiences. In considering how this could be done, we need to look at what is developmental about the current research, and what is not, but could be.
2. What is developmental about disaster research? Since disaster researchers tend to come from a clinical background, it is no surprise that their work is not primarily developmental in focus. But most of the authors in this collection recognize the need for redesigning assessment instruments used with adults so that children can understand them and for developing new instruments specifically for children. Several chapters describe intervention approaches that use materials designed to be developmentally appropriate (Chapter 5, ‘‘Hurricanes and earthquakes’’; Chapter 6, ‘‘Wilderness area and wildfire disasters’’). Some studies have attempted, when possible, to contrast the effects of disasters on children of different ages. How do young children, for example, handle the stress of a flood or hurricane compared with older children or adolescents? This kind of work has the same problem that cross-sectional studies always have, namely, that age differences do not necessarily reflect age-related changes. Longitudinal studies are needed to clarify the relationship between age and time, but aside from a few follow-up studies in the years after disasters, this has not been a major focus. Most follow-up studies have not covered more than a few years and have made no attempt to bridge significant age levels, such as the transition from middle childhood into adolescence. In Chapter 11 (‘‘Dam break: Long-term follow-up of children exposed to the Buffalo Creek disaster’’), Korol, Kramer, Grace, and Green reported a follow-up 17 years after a disaster, but with such a long interval between contacts with the participants, it was difficult to draw any real developmental conclusions from the results.
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Even when age differences are observed in disaster studies, it is hard to know what they might mean. When developmental psychologists do cross-sectional studies, they look at variables that are presumed, based on developmental theory, to have been changing throughout the years in response to normal life activities and physical maturation. But similar developmental trajectories cannot be presumed for postdisaster symptoms, and it is unknown how such symptoms interact with age. At present, we lack a developmental theory of disaster response; thus, cross-sectional studies are limited in what they can tell us. Of course, they should also use different variables. The models used in disaster studies are very symptom based, with PTSD symptoms the most commonly explored. This approach is not developmental—symptoms may be present to a greater or lesser degree, but there is no presumed interaction with time or with biological changes that are normative. Only Chapter 12 (‘‘The traumatic impact of motor vehicle accidents’’ by J. R. Scotti, K. J. Ruggiero, and A. E. Rabalais) actually outlines a theoretical model. Although labeled a ‘‘paradigmatic model of accident-related PTSD,’’ it includes more developmental elements than most of the other chapters do. Among them are ways to approach psychopathology developmentally by identifying (a) deviations from age-appropriate norms, (b) exaggerations of typical development, and (c) behaviors that are pathological because they interfere with typical development. Memory of traumatic events is important and, therefore, so is memory development in children. Emotional, language, cognitive, and sensory-motor development all matter because of their effects on the expression of PTSD symptoms, but genetically based characteristics and biological differences are also stressed. Finally, the child’s learning history prior to the event interacts with learning about the event to produce different outcomes. Many elements of this model could be used to examine children’s responses to other disasters, and the model itself could be expanded to look at more than PTSD symptoms. A final observation is that the chapters on violent disasters seem to take a more developmental approach than the others do. In Chapter 13 (‘‘Shootings, hostage takings, and children’’), Nader and Mello discuss the interaction of adolescence as a period of turmoil and disequilibrium with social environmental forces that include violent media images and the accessibility of weapons. They note that details of traumatic events become embedded in aspects of life following the event and may have negative effects on trust, moral development, and sense of ongoing safety. Similar effects are described in Chapter 14 (‘‘The aftermath of terrorism’’), as well as the effects of television discussed earlier. In Chapter 15 (‘‘Children under stress of war’’), Avigdor Klingman reports that this experience, at adolescence, has a long-lasting effect on survivors’ adult lives. Sociopolitical influences on identity are particularly powerful, and political ideology and commitments may buffer the experience of war. Several developmental assessment approaches are also discussed. Finally, Chapter 16 (‘‘Children’s exposure to community violence’’ by J. Kupersmidt, A. Shahinfar, and M. E. Voegler-Lee) cites evidence that exposure to community violence affects both moral development and the development of maladaptive social information-processing patterns.
3. What, according to the editors, should be more developmental about disaster research? In the final chapter of the book, the four editors offer their recommendations for future directions for research and public policy. A number of these involve taking a more developmental look at children’s responses to disasters, and the editors acknowledge, as a major obstacle, the absence of theories and models for directing research and intervention efforts. They propose moving beyond the symptoms of
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PTSD to the ‘‘larger issue,’’ which is to understand how exposure to disasters at various points in the developmental period affects developmental trajectories in multiple domains, including biological, cognitive, behavioral, and interpersonal functioning. The disaster research field, they argue, needs to move beyond asking what factors predict outcomes and begin to ask why certain variables are important, by what processes certain variables influence children’s reactions, and how those processes vary as a function of children’s development. The editors acknowledge that this task may require new ways of thinking to adapt existing theories to explain children’s reactions to disaster or to develop new theories that are specific to children and disasters. They note that children’s developmental level is an important moderating variable that has not been addressed in most conceptual models of children’s disaster reactions. They offer several examples of relevant variables that change with age, such as the ability to accurately interpret the degree of threat posed by events, threshold and tolerance for arousal, inhibition of the startle reflex, and the ability to attend to multiple dimensions of experience. These are all important and, to a developmental psychologist, exciting recommendations. However, much more could be done, I would argue that an important ‘‘new way of thinking’’ would be to apply both developmental methods and theories to disaster studies.
4. How should developmental methods be used in disaster studies? Developmental questions need to be answered with developmental methods. The disadvantage of not doing this is illustrated in Chapter 10 (‘‘Mass transportation disasters’’) by Yule, Udwin, and Bolton. They describe an event in which a cruise ship with 400 British teenagers aboard was struck by another ship. Most of the students survived, but the dangerous rescue effort involved several deaths and was very traumatic for the survivors. In a 5- to 7-year follow-up study, the authors stated that they wanted to see how the adolescents who experienced this shipping disaster were later negotiating changes into adulthood, especially in the areas of work and intimate relations. But what they assessed in their follow-up study were mental health risk factors, such as PTSD, anxiety disorders, phobias, panic disorders, and depression. No developmental issues, such as identity or intimacy statuses, were studied. The presence or absence of clinical symptoms cannot answer the developmental questions that these researchers were asking, but developmental research methods could. Follow-up studies, especially of this duration, should look at all aspects of development, not just trauma-related symptoms. This is true for at least two reasons: (1) To really understand the effects of disasters on children, we need to see how these experiences have been integrated with all aspects of their development, including (at minimum) cognition, sense of self, identity, moral reasoning, social understanding, and perspective taking. Otherwise, we have no way of knowing, as the coeditors suggest we should know, ‘‘how exposure to disasters at various points in the developmental period affects developmental trajectories in multiple domains.’’ (2) Assessing children’s normal development, as well as their trauma symptoms, would tell us more than we can currently know about recovery from a disaster; at present, we mostly know whether they demonstrate trauma symptoms, but not much else. Of course, systematically following the same individuals over time would be better than collecting group data at an arbitrary point in time after a disaster, which seems to have been the case in some studies. And although several studies in this book reported efforts to document different effects of disasters on children of different ages, none
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were able to follow those children longitudinally to see how they resolved developmental issues as they matured. One of the reasons why this would be interesting is that some of these studies found the immediate or short-term effects of trauma to be less for younger than for older children. But without longitudinal work, we cannot know if this continued to be true, or if there were ‘‘sleeper’’ effects on younger children as they moved into different developmental phases. Among children who had no risk factors before the disaster, older children would have more years of normal development behind them than younger children do, and although their initial symptoms might look worse, their eventual integration of the experience might be better due to their more advanced development. Another use for longitudinal studies would be in contrasting the effects of different kind of disasters on children. Almost all disaster studies look for the same symptoms (PTSD, anxiety, and depression) and usually find them. But do children really experience natural disasters, such as floods or hurricanes, in the same way they experience wars, hostage takings, or neighborhood shootings? This seems very important to investigate because terrible events caused by nature are different in many ways from acts of violence. It is one thing for children to learn that no one is safe from some forces of nature; it is quite another to be faced early in life with the many ways in which humans are not safe from each other. Longitudinal developmental studies that look at how the particular event becomes a part of children’s ongoing understanding of the world might show us whether the trauma of violence had a different long-term effect on the developing personality than the trauma of natural disasters had. A more developmental approach also could be taken with the construct of PTSD, around which much of the research literature in this area revolves. Most studies have found that children and adolescents report high levels of PTSD following disasters. For a person to be identified as experiencing PTSD, three symptom clusters must be met: reexperiencing (recurrent thoughts about the event; intense stress at reminders of the event), avoidance or numbness (avoiding feelings or reminders of the event, detachment or removal from others, diminished interest in normal activities), and hyperarousal (difficulty sleeping, hypervigilance, angry outbursts, exaggerated startle response). These important symptoms should not, as Silverman and La Greca point out in Chapter 1, be the only thing we study about children, and they note that anxiety and depressive disorders have also been observed. But what is most interesting from a developmental perspective is Silverman and La Greca’s point that it is not very clear from existing research the extent to which these symptoms ‘‘interfere with children’s day-to-day functioning and thus may be pathological, or, alternatively, whether the symptoms might be considered to be normal reactions to abnormal events.’’ How do we decide what is pathological about children’s responses to catastrophic events? Interference with day-to-day functioning seems a very minimal criterion for calling something pathological. What really is normal functioning? Is it normal to go to school, play with your friends, and act as if nothing has happened, when indeed, something unthinkable has? Theories of development might provide a deeper way of looking at how children process disasters and integrate such events with their larger understanding of their world.
5. How should developmental theories be used in disaster studies? What is mostly missing in this literature is a connection with any particular developmental theory. Some studies show how crises interrupt or disrupt age-appropriate activities, but they do not use
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developmental theories to explore how the crisis experience is ultimately integrated into the life course development of the individual. As children recover from disasters, are they the same people they were before, or are they different in some ways that will always be with them? Some developmental theories seem particularly relevant to certain disasters, although they have been largely untapped by researchers. For example, cognitive development is mainly discussed in terms of limitations on children’s ability to understand key concepts relating to why disasters happen or what they mean, or to understand assessment instruments originally designed for adults. But aside from consideration of children’s cognitive limits, there is little study of the relation between cognitive development and particular disasters. How well do children understand natural disasters and what causes them? Studies of natural disasters should take into account what children actually know about natural phenomena. The intuitive theory approach used in many developmental studies (e.g., Carey, 1985, 1991; Keil, 1989, 1992) focuses on children’s developing theories of the biological and physical world. It could offer a useful framework for exploring children’s comprehension of natural disasters. Cognitive variables are relevant to toxic waste disasters as well. This is one area where studies have found children’s distress to be significantly less than that of adults, probably because children do not understand that they may be at risk for future birth defects in their own children from their present exposure to toxic waste (Chapter 9, ‘‘Toxic waste spills and nuclear accidents,’’ by M. C. Wroble and A. Baum). Comprehending the risk of future birth defects and the role of toxic waste exposure in creating that risk probably requires both specific information about genetics and advanced cognitive development. But if only distress is measured and not understanding, the relation between cognition and distress cannot be established. This relationship, while alluded to in several studies, is not really explored, because the studies typically do not assess children’s and adolescents’ actual understanding of disasters. Whether they experience natural disasters or political upheavals, children’s understanding of the world is very likely to affect their reactions, but we cannot demonstrate that if we only study their reactions and not their understanding. Other disasters relate to other developmental theories, offering a number of possibilities to be explored. Studies of hostage taking and terrorism could look at the effects of these experiences on the development of perspective taking, using the work of Selman (1976). Studies of children growing up in war zones, where people who look very much like them are nevertheless identified as their enemies, may find developmental research on identity by Erikson (1963) and contemporary researchers (Marcia, Waterman, Matteson, Archer, & Orlofsky, 1993) to be helpful. Finally, many studies of children’s reactions to disaster could be usefully informed by research in the development of event and autobiographical memory (Nelson, 1996), especially memory for unusual and noteworthy events (Hammond & Fivush, 1991). Using developmental theories could give us a broader understanding of the lifelong effects of disaster on children, but developmental theories should also expand to account for the effects of disasters. Most theories of human development assume certain ‘‘normative’’ life experiences for children, and while disasters are not normative, they are, unfortunately, too common to be ignored.
6. Conclusion This book, published in 2002, does not include research related to the events of September 11, 2001. Much research about those events has begun, as evidenced by the many presentations at the
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2003 meetings of the Society for Research in Child Development. More researchers are studying international terrorism and its effects on children, and this volume is very informative to that work, especially the chapters on hostage taking, war, and the aftermath of terrorism. But the current climate of global threat also calls for a more developmental approach because all children are affected, at least indirectly, and more children are experiencing violence as an ongoing part of life rather than a one-time event. Thus, we should be studying not just the immediate effects of particular events, but how the whole concept of terrorism affects children’s understanding of their world. La Greca, Silverman, Vernberg, and Roberts, along with the individual chapter authors, have done a superb job with the important but surely unpleasant task of describing just how bad things can get in this world and just how seriously those things can affect the development of our young people. Even with their dispassionate style of presentation, the evidence is harrowing, particularly in the chapters on violence. It is important for developmental psychologists to think about integrating this material with our theories of human development. Natural disasters will always be a part of life on this planet. But as we typically describe it, normative development does not (and should not) include learning how to behave in a hostage situation, protecting yourself from sniper fire, watching your friends and family get shot, seeing bloody, mutilated bodies, and dealing with death threats from gang members. As knowledge of these horrors become more widespread, we should share with our clinical colleagues the task of documenting the evidence that development cannot progress normally under these conditions. Annette La Greca and her colleagues offer many recommendations to governments and policymakers for handling disasters of all kinds. But none is more powerful than the book in its entirety, which offers a thorough and comprehensive message that all of our children deserve a better world than this.
References Carey, S. (1985). Conceptual changes in childhood. Cambridge, MA: Bradford/MIT Press. Carey, S. (1991). Knowledge acquisition: Enrichment or conceptual change? In S. Carey, & R. Gelman (Eds.), The epigenesis of mind: Essays on biology and cognition ( pp. 257 – 291). Hillsdale, NJ: Lawrence Erlbaum Associates. Erikson, E. H. (1963). Childhood and society (2nd ed.). New York: Norton. Gurwitch, R. H., & Pfefferbaum, B. (1999, February). Children and trauma: Lessons from the Oklahoma City bombing. Paper presented at the Rocky Mountain Region Disaster Mental Health Conference, Laramie, WY. Hammond, N. R., & Fivush, R. (1991). Memories of Mickey Mouse: Young children recount their trip to Disney world. Cognitive Development, 6, 433 – 438. Keil, F. C. (1989). Concepts, kinds, and cognitive development. Cambridge, MA: MIT Press. Keil, F. C. (1992). The origins of autonomous biology. In M. R. Gunnar, & M. Maratsos (Eds.), Modularity and constraints in language and cognition. Minnesota symposia on child psychology (Vol. 25, pp. 103 – 137). Hillsdale, NJ: Lawrence Erlbaum Associates. Marcia, J. E., Waterman, A. S., Matteson, D. R., Archer, S. L., & Orlofsky, J. L. (Eds.). (1993). Ego identity: A handbook for psychosocial research. New York: Springer-Verlag. Nelson, K. (1996). Language in cognitive development: The emergence of the mediated mind. New York: Cambridge University Press. Pfefferbaum, B., Nixon, S., Tivis, R., Doughty, D., Pynoos, R., Gurwitch, R. H., & Foy, D. (2001). Television exposure in children after a terrorist incident. Psychiatry, 64, 202 – 211. Selman, R. L. (1976). Social-cognitive understanding: A guide to educational and clinical practice. In T. Lickona (Ed.), Moral development and behavior: Theory, research, and social issues (pp. 299 – 316). New York: Holt, Rinehart, and Winston.
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Yule, W., ten Bruggencatte, S., & Joseph, S. (1994). Principal components analysis of the impact of events scale in children who survived a shipping disaster. Personality and Individual Differences, 16, 685 – 691. Yule, W., & Udwin, O. (1991). Screening child survivors for post-traumatic stress disorders: Experiences from the ‘‘Jupiter’’ sinking. British Journal of Clinical Psychology, 30, 1051 – 1061.
Bridget A. Franks Department of Educational Psychology, University of Florida, 1403 Norman Hall, P.O. Box 117047, Gainesville, FL 32611, USA E-mail address: [email protected]