TABLE 1

Common Symptoms of Adjustment Reactions in Children after a Disaster24

Sleep problems: difficulty falling or staying asleep, frequent night awakenings or difficulty awakening in the morning, nightmares, or other sleep disruptions.
Eating problems: loss of appetite or increased eating.
Sadness or depression: may result in a reluctance to engage in previously enjoyed activities or a withdrawal from peers and adults.
Anxiety, worries, or fears: children may be concerned about a repetition of the traumatic event (eg, become afraid during storms after surviving a tornado) or show an increase in unrelated fears (eg, become more fearful of the dark even if the disaster occurred during daylight). This may present as separation anxiety or school avoidance.
Difficulties in concentration: the ability to learn and retain new information or to otherwise progress academically.
Substance abuse: the new onset or exacerbation of alcohol, tobacco, or other substance use may be seen in children, adolescents, and adults after a disaster.
Risk-taking behavior: increased sexual behavior or other reactive risk-taking can occur, especially among older children and adolescents.
Somatization: children with adjustment difficulties may present instead with physical symptoms suggesting a physical condition.
Developmental or social regression: children (and adults) may become less patient or tolerant of change, revert to bedwetting, or become irritable and disruptive.
Posttraumatic reactions and disorders: see Table 2.