Quake stress hurting our young
Research is showing that the Canterbury earthquakes have caused more trauma in young children than expected. So how bad is it and what can be done? JOHN McCRONE reports.
It could be serious. Researchers say they do not want to alarm, but a generation of children may be carrying around the unprocessed trauma of the Canterbury earthquakes.
Canterbury University school of health sciences associate professor Dr Kathleen Liberty says a study of 5-year-olds starting primary school in east and south Christchurch is finding that as many as one in five now exhibit the classic symptoms of post- traumatic stress disorder (PTSD).
"These kids are having difficulty coping which shows through being irritable and clingy. They are aggressive and withdrawn - both reactions to anxiety. They are having difficulties concentrating, difficulties learning, difficulties working in groups with other children."
The level of trauma is unexpectedly high. Liberty says people are probably being caught out by the myth that young children are less formed and therefore more resilient to life shocks than adults.
The belief is that any psychological effect of the quakes ought to be forgotten quickly and so the problem is going unrecognised, she says. "Parents will just think their kids are acting up."
And even the professionals are being fooled. "One of the things we worry about is that children are being diagnosed with developmental disabilities like ADHD (attention deficit and hyperactivity disorder) when the reason they're having difficulty concentrating relates to the earthquakes."
Doctors could be prescribing medication which is no help at all.
Liberty says it is those aged 2 to 8 at the time of the earthquakes who look to be at particular risk because of a lack of understanding of events. And there is the obvious question of what will happen once this age group become Canterbury's teenagers in another few years.
Dr Akiko Nanami, a visiting researcher from Hiroshima Shudo University, says a decade after Japan's devastating 1995 Kobe earthquake, the city saw a sharp spike in teen suicide and delinquency.
Nanami says immediately after the Kobe quake, children seemed cautious - apparently "holding it in", trying to be good for the adults, much like kids do when their parents are in the middle of stormy divorce. But later it had to come out.
Auckland University education researcher Dr Carol Mutch, who has been working with several Canterbury schools on "healing" projects like an earthquake mosaic at Kaiapoi North, says teachers are seeing totally different children.
Mutch says one primary school had a crazy hair day before Christmas. "Usually they would go wild, be creative, really dress up." But this time it was heart-breaking how restrained the children were. "You only saw a few tame pigtails and pink ribbons."
Liberty tries to avoid words like "a ticking timebomb". She says the honest answer is that Canterbury is in uncharted territory.
Despite all the disaster recovery literature, there is simply not the research to tell how it is going to pan out - what percentage of the currently trauma-affected will be affected in some longer term way.
Liberty says we do not even really know how to treat this particular kind of trauma in the very young. There are many more questions than answers at the moment.
But parents, professionals and the public need to realise that the Canterbury earthquakes had several unique features that mean they could have been more damaging to child mental health than at first anticipated.
STUDY INVOLVES 100 CHILDREN
Liberty confesses her PTSD study is only small and preliminary. Done by a team at the school of health studies including Dr Sonja Macfarlane and Dr Jeffrey Gage, it involves four primaries and 100 children on the worst affected side of Christchurch.
The first results were presented at a symposium, Researching the Health Implications of Seismic Events (Rhise), late last year.
But the group was "lucky" in that it had been surveying teacher impressions of new 5-year-olds at the same schools for several years before the earthquakes, looking at the impact of asthma, family issues and other problems on school readiness. So the group had a baseline of comparison for picking up the quake-related changes.
And if anything, Liberty says, the results are an underestimate as parents of some of the most disturbed children did not want to add to their anxiety by putting them into the latest study.
So what are the actual figures then? Pre-quake, says Liberty, the number of children demonstrating signs of PTSD due to "normal life" was already a concern, touching an average of 5 per cent. But in the 2013 intake, it ranged in the four schools from 14 to 21 per cent.
"The teachers are really noticing it," says Macfarlane, chipping in. "We're hearing repeated stories about playground behaviour - that children aren't playing the same, not sharing, that there's a lot more fighting, aggression and anger."
Liberty says the children seem more infantile, as if the shock of the earthquakes and the stress of the recovery have held back their development.
Before the quakes, teachers rated 45 per cent of the 5-year-old school-starters as competent in their language. That has dropped to 27 per cent. Likewise, academic readiness has dropped from 28 to 18 per cent, and good coping skills has dropped from 24 to 12 per cent.
Liberty says it is a dramatic shift that means classes have gone from having one or two problem kids to classes where learning and socialisation risks being disrupted for all the children.
So why so bad? Natural disasters happen everywhere in the world. History is full of wars and far worse events. Isn't there a danger here in over-playing the psychological impact in Canterbury?
Liberty replies there are two things going on. Partly it is just that as a developed nation, New Zealand has high expectations. Given the competitive nature of modern life, where social and academic skills matter, we are concerned if children are falling behind even slightly.
But also, look at the Canterbury quakes through a child's eyes, she says.
QUAKES ARE ESPECIALLY STRESSFUL
Earthquakes are especially stressful events because of the way they strike out of the blue without warning. With wars, floods, storms and even bushfires, there is usually advanced notice that something bad is coming.
And then the Canterbury quake sequence was exceptional in that the big ones kept happening over and over.
"The earthquakes lasted from September 2010 right until January 2012. Most people don't realise that's when we had the last magnitude 5. So a 16-month period. And if a child was 3 or 4 at the time, we're talking about a third of their lives."
Liberty says there is the expectation that young children ought to be more immune to such stress. After all, adults are the ones with the extra responsibilities and burdens. Yet of course, the first few years are already a tumultuous stage of life.
"The same children are also going through these pretty rapid stages of cognitive, emotional, social, physical and cultural change. And the research indicates there are sensitive periods for this development which ongoing fear and stress is going to disrupt."
So for primary-school-age children, there has been a prolonged exposure to unpredictable shocks. Then there has also been the recovery - or rather, for many families, the further stress of living with home dislocation, insurance battles, job uncertainties, relationship troubles. All the human problems piled on top of the physical threat.
And then whereas older children can talk it through, get some understanding of events, younger children only have the earthquakes as their reality. They have no way to digest the meaning.
Macfarlane, who works with Maori families, says that while they are often living in poorer circumstances, the study suggests that Maori children are faring better psychologically because of the closer support of whanau and a spiritual approach that makes more sense to the very young.
Macfarlane says for instance it is more acceptable for the family to share a bed, which is important in comforting a frightened child. And the earthquakes are explained in a human context, not as a lesson in plate tectonics. "One mother talked about Ruaumoko [the earthquake god], saying he's having a bad day, he's shaking."
Liberty says one thing the team would like to study are these kinds of protective factors. But right now the priority is simply alerting people that there is an emerging problem.
She says going on the experience of other natural disasters, the Canterbury health service did gear up for a surge in physical ailments - heart attacks and other quake related illness. However mostly, like the predicted gastro outbreaks from broken pipes and dirty water, the numbers have been better than anticipated.
Yet now, several years on, the mental health impact on young children is showing Canterbury to have been underprepared.
It could be teenagers too. Liberty says the evidence is anecdotal, but she is hearing from secondary schools that whereas NCEA results initially rose in the midst of the quakes due to adrenaline and conscientiousness, last year some real problems of lethargy and concentration started to show.
Again, says Liberty, it is taking time for the full effects of the earthquakes to emerge. So the question now is how bad is it, and what can be done?
DIFFICULT FOR YOUNGER CHILDREN TO PROCESS FEELINGS
How do you help? Auckland's Mutch, a former Canterbury College of Education researcher, stumbled into her project by accident.
Mutch won a small United Nations grant to record the earthquake memories of primary- school children and it quickly grew into a form of community therapy.
She says the difficulty for younger kids is processing their feelings. But the natural response of many parents, and even some schools, has been to wrap up their children in cotton wool.
Indeed people were explicitly warned about revisiting memories of the day of an actual quake. "They were told there was the risk of re-traumatising the children - making things worse."
So when she approached some schools last year, Mutch found the teachers wanted to pretend life was back to normal. "They told me, oh, our kids are so over the quakes." And yet there was all the evidence of ongoing distress, such as clinginess, thumb-sucking, bed-wetting and lack of concentration.
Mutch changed her plans. Rather than going in as a "white coat and clipboard" researcher to conduct interviews, she got the pupils to invent their own earthquake narratives, telling their stories in a way that would create an objective distance and help make sense of the past few years.
Some of the primary schools created an earthquake book, others an earthquake documentary. Kaiapoi North decided on a schoolground mosaic which it plans to complete in time for February 22.
Mutch says the mosaic is a circle of four panels - old Kaiapoi, immediately pre-quake Kaiapoi, the earthquakes themselves, and then the recovery. The materials are broken crockery, tiles and bricks salvaged from shattered homes. There will be plants rescued from abandoned back gardens. The local Menz Shed is making a central bench.
As you would expect, says Mutch, the pre-quake images are all happy blues and yellows, the quake panel all dark and jagged pieces.
The pupils at Burwood Primary - which last year had the added trauma of being closed and merged with Windsor School as part of the Government's "education renewal" programme - plumped to do a documentary.
Mutch says the pupils were encouraged to take a step back and tell the story at one remove. "We suggested things like: 'Wow, we've been through something quite big in history. Imagine you're a grandparent and your grandchild is sitting there, asking you what was it like in the earthquakes?' So it became a narrative."
One boy happened to be up a tree at the time and the class filmed him in the same tree. "They were the ones with the camera, in control. They could shape the story in a way that allowed them to then own it."
Mutch says this year she and her research team will be going back to find if the projects have indeed benefited the children. But what surprised her was how they all became larger family and community efforts, too.
Mutch found that parents wanted to come along with their older children to be interviewed as a group. "I would have these parents who might seem inarticulate, who would sit there looking at their hands, and you would think this is only going to take 10 minutes. But an hour and a half later, they would still be talking."
This betrayed a general need across all ages to process and calibrate events, to share earthquake experiences and even now, several years later, start to tell it as a collective story. Mutch feels this is what is of most healing value - taking the undigested personal feelings and integrating them into the larger perspective, the common memory.
"I had a mother who was hearing for the first time her son had been in Colombo St on February 22. They had never talked about it because he didn't want to worry her."
For younger children especially, says Mutch, interpreting the earthquakes in terms of the collective experience seems an important exercise.
THE YOUNGER THE CHILREN, THE MORE SEVERELY AFFECTED
Returning to the PTSD findings, is Canterbury looking at a war generation of children, a group with social problems for years to come?
Liberty sighs. We need to be careful to separate what we know from what we don't know, she says. "And we don't know enough to answer that." However she adds: "The research does indicate that the younger the kids, the more severely affected they are. So this might just be the tip of the iceberg."
There are the snowball effects. Liberty says children entering school with concentration problems are going to struggle to learn to read. Then their failure will make them feel bad. Already their path in life is being altered.
The practical advice seems obvious. Liberty says there are no anti-anxiety drugs that are known to work with PTSD and even standard one-on-one counselling techniques, like cognitive therapy, are wrong for primary-school-age children.
But the key is to identify earthquake trauma as the issue, then to make adjustments. "If a child is having stress reactions, it's really important to be patient, to realise it might take a long time to recover. So as a parent, try not to pile on anxiety if they're struggling to read or struggling with their siblings and friends."
Liberty says she recently raised a gasp of horror from a room of special education teachers when she remarked; what if a child does not learn to read until 10? Yet later in the session, one of the teachers realised her 5-year-old daughter's behavioural difficulties might be quake-related. "It wasn't until after a whole day she saw it could apply to her own child."
Liberty says expectations will need to be adjusted at the official level too. "What are teachers going to do when their schools are being marked on the number of kids who meet national standards? That's not going to be happening in Christchurch."
SLEEP ISSUES COMMON
Sleep is another obvious issue to address, she says. PTSD disrupts sleep patterns. There is bed-wetting, nightmares, a resistance to going to bed. However, tired children will only compound their problems. "Parents will need to pay special attention to a routine - no electronics before bed, but instead a period of closeness, perhaps reading a book together."
The public have a role as well. Liberty says she does not want people now looking at every 5-year- old and assuming the child must be traumatised. But if there seems to be a rash of bratty infants at the supermarket checkouts at the moment, there could be reason to show more tolerance than usual.
As to the long term, her suspicion is that the responses of individual children may vary greatly. It is not going to be a one-size-fits-all story.
Liberty says the way to look at it is that children growing up through the Canterbury earthquakes have been swept along on a great river of events. It has been traumatic for many, set them back in some ways, yet they may have also been learning other kinds of life lessons.
"There are different kinds of things these 5-year-olds know that kids before the earthquakes didn't know."
So the youngsters starting school this year may well seem delayed in speech and self-control compared to pre-quake children, but Liberty says some of them may eventually take away positive meanings as well as the negative ones.
Liberty sketches out mental health trajectories on a sheet of paper. The research says there are those who seem oblivious to stress, those who show PTSD symptoms but rebound quickly, and those who show symptoms and are left permanently marked.
But then there are also those who show post-trauma growth - whose psychological curve first dips and then rebounds to a higher level than ever before. Their response to their suffering is somehow their making.
Even generally, the earthquake experiences might leave children more community-minded or competent in other ways, she adds optimistically. "These children, when they grow up, might be our best copers."
However, that is for the future. It is too early to tell how the numbers will work out for Canterbury, Liberty says. What matters right at the moment is realising that there is in fact a problem.